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Sample records for endoscopic retrograde cholangiopancreaticography

  1. Pancreatitis with an unusual fatal complication following endoscopic retrograde cholangiopancreaticography: a case report

    PubMed Central

    Kanen, Boris; Loffeld, Ruud JLF

    2008-01-01

    Introduction Endoscopic retrograde cholangiopancreaticography has been the treatment of choice for stones in the common bile duct. Although the procedure is usually safe, procedure-related complications do occur. Case presentation A case of pancreatitis following endoscopic retrograde cholangiopancreaticography is described in a 55-year-old woman. After an uneventful recovery the patient's condition deteriorated rapidly 16 days after the endoscopic retrograde cholangiopancreaticography, and the patient died within 1 hour. Post-mortem examination revealed massive intrapulmonary fat embolism. The complications of endoscopic retrograde cholangiopancreaticography and pancreatitis are described. Conclusion Fat embolism can occur after the remission of pancreatitis and pancreatic necrosis may be overlooked on contrast-enhanced computed tomography scanning. PMID:18577211

  2. Repeat endoscopic retrograde cholangiopancreaticography after failed initial precut sphincterotomy for biliary cannulation

    PubMed Central

    Pavlides, Michael; Barnabas, Ashley; Fernandopulle, Nilesh; Bailey, Adam A; Collier, Jane; Phillips-Hughes, Jane; Ellis, Anthony; Chapman, Roger; Braden, Barbara

    2014-01-01

    AIM: To investigate the outcome of repeating endoscopic retrograde cholangiopancreaticography (ERCP) after initially failed precut sphincterotomy to achieve biliary cannulation. METHODS: In this retrospective study, consecutive ERCPs performed between January 2009 and September 2012 were included. Data from our endoscopy and radiology reporting databases were analysed for use of precut sphincterotomy, biliary access rate, repeat ERCP rate and complications. Patients with initially failed precut sphincterotomy were identified. RESULTS: From 1839 consecutive ERCPs, 187 (10%) patients underwent a precut sphincterotomy during the initial ERCP in attempts to cannulate a native papilla. The initial precut was successful in 79/187 (42%). ERCP was repeated in 89/108 (82%) of patients with failed initial precut sphincterotomy after a median interval of 4 d, leading to successful biliary cannulation in 69/89 (78%). In 5 patients a third ERCP was attempted (successful in 4 cases). Overall, repeat ERCP after failed precut at the index ERCP was successful in 73/89 patients (82%). Complications after precut-sphincterotomy were observed in 32/187 (17%) patients including pancreatitis (13%), retroperitoneal perforations (1%), biliary sepsis (0.5%) and haemorrhage (3%). CONCLUSION: The high success rate of biliary cannulation in a second attempt ERCP justifies repeating ERCP within 2-7 d after unsuccessful precut sphincterotomy before more invasive approaches should be considered. PMID:25278710

  3. Endoscopic retrograde cholangio pancreatography (ERCP) - slideshow

    MedlinePlus

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  4. Huge biloma after endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy

    PubMed Central

    Alkhateeb, Harith M.; Aljanabi, Thaer J.; Al-azzawi, Khairallh H.; Alkarboly, Taha A.

    2015-01-01

    Background Biliary leak can occur as a complication of biliary surgery, endoscopic retrograde cholangiopancreatography manipulations and endoscopic biliary sphincterotomy. Consequently, bile may collect in the abdominal cavity, a condition called biloma. Rarely, it may reach a massive size. Case presentation A 72-year-old man presented with gastric upset with gradual abdominal distension reaching a large size due to intra-abdominal bile collection (biloma) after endoscopic retrograde cholangiopancreatography plus endoscopic biliary sphincterotomy and stenting for post laparoscopic cholecystectomy common bile duct stricture. This huge biloma was treated by percutaneous insertion of a tube drain for a few days, evacuating the collection successfully without recurrence. Discussion This patient might sustain injury to the common bile duct either by the guide wire or stent, or the injury occurred at the angle between the common bile duct and duodenum during sphincterotomy of the ampulla. Although any of these rents may lead to a bile leak, causing a huge biloma, they could be successfully treated by percutaneous drainage. 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. PMID:26402876

  5. Endoscopic prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis

    PubMed Central

    Lee, Tae Hoon; Park, Do Hyun

    2014-01-01

    Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is not an uncommon adverse event but may be an avoidable complication. Although pancreatitis of severe grade is reported in 0.1%-0.5% of ERCP patients, a serious clinical course may be lethal. For prevention of severe PEP, patient risk stratification, appropriate selection of patients using noninvasive diagnostic imaging methods such as magnetic resonance cholangiopancreatography or endoscopic ultrasonography (EUS), and avoidance of unnecessary invasive procedures, are important measures to be taken before any procedure. Pharmacological prevention is also commonly attempted but is usually ineffective. No ideal agent has not yet been found and the available data conflict. Currently, rectal non-steroidal anti-inflammatory drugs are used to prevent PEP in high-risk patients, but additional studies using larger numbers of subjects are necessary to confirm any prophylactic effect. In this review, we focus on endoscopic procedures seeking to prevent or decrease the severity of PEP. Among various cannulation methods, wire-guided cannulation, precut fistulotomy, and transpancreatic septostomy are reviewed. Prophylactic pancreatic stent placement, which is the best-known prophylactic method, is reviewed with reference to the ideal stent type, adequate duration of stent placement, and stent-related complications. Finally, we comment on other treatment alternatives, and make the point that further advances in EUS-guided techniques may afford useful PEP prophylaxis. PMID:25469026

  6. Endoscopic retrograde cholangiopancreatography during pregnancy without radiation

    PubMed Central

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

    2009-01-01

    AIM: To present our experience with pregnant patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) without using radiation, and to evaluate the acceptability of this alternative therapeutic pathway for ERCP during pregnancy. METHODS: Between 2000 and 2008, six pregnant women underwent seven ERCP procedures. ERCP was performed under mild sedoanalgesia induced with pethidine HCl and midazolam. The bile duct was cannulated with a guidewire through the papilla. A catheter was slid over the guidewire and bile aspiration and/or visualization of the bile oozing around the guidewire was used to confirm correct cannulation. Following sphincterotomy, the bile duct was cleared by balloon sweeping. When indicated, stents were placed. Confirmation of successful biliary cannulation and stone extraction was made by laboratory, radiological and clinical improvement. Neither fluoroscopy nor spot radiography was used during the procedure. RESULTS: The mean age of the patients was 28 years (range, 21-33 years). The mean gestational age for the fetus was 23 wk (range, 14-34 wk). Five patients underwent ERCP because of choledocholithiasis and/or choledocholithiasis-induced acute cholangitis. In one case, a stone was extracted after precut papillotomy with a needle-knife, since the stone was impacted. One patient had ERCP because of persistent biliary fistula after hepatic hydatid disease surgery. Following sphincterotomy, scoleces were removed from the common bile duct. Two weeks later, because of the absence of fistula closure, repeat ERCP was performed and a stent was placed. The fistula was closed after stent placement. Neither post-ERCP complications nor premature birth or abortion was seen. CONCLUSION: Non-radiation ERCP in experienced hands can be performed during pregnancy. Stent placement should be considered in cases for which complete common bile duct clearance is dubious because of a lack of visualization of the biliary tree. PMID:19653343

  7. Endoscopic retrograde cholangiopancreatography in ruptured liver hydatid cyst.

    PubMed

    Borahma, Mohamed; Afifi, Rajaa; Benelbarhdadi, Imane; Ajana, Fatima Zahra; Essamri, Wafaa; Essaid, Abdellah

    2015-07-01

    One of the most common and serious complications of hepatic hydatid cyst disease is communication between the cyst and the biliary tree. Surgical management of biliary fistula is associated with high morbidity and mortality. We retrospectively reviewed the effectiveness of endoscopic treatment of ruptured hydatid cyst into intrahepatic bile ducts. Diagnosis of intrabiliary rupture of hydatid cyst was mostly suspected by acute cholangitis, jaundice, pain, and/or persistent external biliary fistula after surgery. The diagnosis was confirmed by radiology and endoscopic retrograde cholangiopancreatography (ERCP) findings. We retrospectively reviewed clinical, laboratory, imagery, and ERCP findings for all patients. The therapeutic methods performed were endoscopic sphincterotomy, extraction by balloon or Dormia basket, stenting, or nasobiliary drainage. Sixteen patients with ruptured hepatic hydatid cyst into bile ducts were seen in 9 years. Nine of 16 patients had a surgical history of hepatic hydatid cyst and three patients had a percutanous treatment history. We carried out ERCP with sphincterotomy and extraction of hydatid materials (extraction balloon n = 11; Dormia basket n = 5) or biliary drainage (nasobiliary drainage n = 1; biliary stenting n = 1). The fistula healed in 80 % of patients with a median time of 6 weeks [range, 1-12] after endoscopic treatment. ERCP was an effective method of treatment for hepatic hydatid cyst with biliary fistula. PMID:26345677

  8. Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management

    PubMed Central

    Vezakis, Antonios; Fragulidis, Georgios; Polydorou, Andreas

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become an important therapeutic modality for biliary and pancreatic disorders. Perforation is one of the most feared complications of ERCP and endoscopic sphincterotomy. A MEDLINE search was performed from 2000-2014 using the keywords “perforation”, “ERCP” and “endoscopic sphincterotomy”. All articles including more than nine cases were reviewed. The incidence of ERCP-related perforations was low (0.39%, 95%CI: 0.34-0.69) with an associated mortality of 7.8% (95%CI: 3.80-13.07). Endoscopic sphincterotomy was responsible for 41% of perforations, insertion and manipulations of the endoscope for 26%, guidewires for 15%, dilation of strictures for 3%, other instruments for 4%, stent insertion or migration for 2% and in 7% of cases the etiology was unknown. The diagnosis was made during ERCP in 73% of cases. The mechanism, site and extent of injury, suggested by clinical and radiographic findings, should guide towards operative or non-operative management. In type I perforations early surgical repair is indicated, unless endoscopic closure can be achieved. Patients with type II perforations should be treated initially non-operatively. Non-operative treatment includes biliary stenting, fasting, intravenous fluid resuscitation, nasogastric drainage, broad spectrum antibiotics, percutaneous drainage of fluid collections. Non-operative treatment was successful in 79% of patients with type II injuries, with an overall mortality of 9.4%. Non-operative treatment was sufficient in all patients with type III injuries. Surgical technique depends on timing, site and size of defect and clinical condition of the patient. In conclusion, diagnosis is based on clinical suspicion and clinical and radiographic findings. Whilst surgery is usually indicated in patients with type I injuries, patients with type II or III injuries should be treated initially non-operatively. A minority of them will finally require surgical

  9. Selective biliary cannulation techniques for endoscopic retrograde cholangiopancreatography procedures and prevention of post- endoscopic retrograde cholangiopancreatography pancreatitis.

    PubMed

    Mukai, Shuntaro; Itoi, Takao

    2016-06-01

    Numerous endoscopic retrograde cholangiopancreatography (ERCP) techniques have been reported to achieve selective biliary cannulation success. For standard biliary cannulation procedures, the wire-guided cannulation technique has been reported to reduce the rate of post-ERCP pancreatitis (PEP) and increase the biliary cannulation success rate, although conflicting reports exist. The pancreatic or double-guidewire technique and several precut techniques have been reported as useful techniques in difficult biliary cannulation cases. Although ERCP is a useful endoscopic procedure, the risk of adverse events, particularly post-ERCP pancreatitis, is inevitable. Previous studies and analyses have revealed the risk factors for PEP. The efficacy of prophylactic pancreatic duct stent placement and the administration of rectal nonsteroidal anti-inflammatory drugs for preventing PEP has also been reported. Herein, we reviewed reports in the literature regarding the current status of selective biliary cannulation techniques and PEP prevention. PMID:26782710

  10. Recent Advanced Endoscopic Management of Endoscopic Retrograde Cholangiopancreatography Related Duodenal Perforations

    PubMed Central

    Park, Seon Mee

    2016-01-01

    The management strategy for endoscopic retrograde cholangiopancreatography-related duodenal perforation can be determined based on the site and extent of injury, the patient’s condition, and time to diagnosis. Most cases of perivaterian or bile duct perforation can be managed with a biliary stent or nasobiliary drainage. Duodenal wall perforations had been treated with immediate surgical repair. However, with the development of endoscopic devices and techniques, endoscopic closure has been reported to be a safe and effective treatment that uses through-the-scope clips, ligation band, fibrin glue, endoclips and endoloops, an over-the-scope clipping device, suturing devices, covering luminal stents, and open-pore film drainage. Endoscopic therapy could be instituted in selected patients in whom perforation was identified early or during the procedure. Early diagnosis, proper conservative management, and effective endoscopic closure are required for favorable outcomes of non-surgical management. If endoscopic treatment fails, or in the cases of clinical deterioration, prompt surgical management should be considered. PMID:27484814

  11. Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma

    PubMed Central

    Uppal, Dushant S; Wang, Andrew Y

    2015-01-01

    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. PMID:26140095

  12. Vesicourethral fistula after retrograde primary endoscopic realignment in posterior urethral injury.

    PubMed

    Arora, Rajat; John, Nirmal Thampi; Kumar, Santosh

    2015-01-01

    A 22-year-old male patient presented with iatrogenic vesicourethral fistula after immediate retrograde endoscopic realignment of urethra after a posterior urethral injury associated with pelvic fracture. PMID:25440761

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

    PubMed

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

    2016-02-10

    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

  14. Unusual Complications Related to Endoscopic Retrograde Cholangiopancreatography and Its Endoscopic Treatment

    PubMed Central

    Kwon, Chang-Il; Song, Sang Hee; Hahm, Ki Baik

    2013-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP)-induced complications, once occurred, can lead to significant morbidity. Commonly 5% to 10% of patients experience procedure related complications such as post-ERCP pancreatitis, biliary hemorrhage, and cholangitis, in descending order. However, complications such as perforation, pneumothorax, air embolism, splenic injury, and basket impaction are rare but are associated with high mortality if occurred. Such unexpected unusual complications might extend the length of hospitalization, require urgent surgical intervention, and put the patient in miserable condition leading to permanent disability or mortality. Although these ERCP-induced complications can be minimized by a skilled operator using advanced techniques and devices, the occurrence of unusual complications are hard to expect and induce very difficult management condition. In this review, we will focus on the uncommon complications related to ERCP. This review is also aimed at suggesting optimal endoscopic treatment strategies for several complications based on our institutional experiences. PMID:23767036

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

    PubMed Central

    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

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

    PubMed

    Altonbary, Ahmed Youssef; Bahgat, Monir Hussein

    2016-03-25

    Periampullary diverticulum (PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD is usually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography (ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD, suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation. PMID:27014423

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

    PubMed Central

    Altonbary, Ahmed Youssef; Bahgat, Monir Hussein

    2016-01-01

    Periampullary diverticulum (PAD) is duodenal outpunching defined as herniation of the mucosa or submucosa that occurs via a defect in the muscle layer within an area of 2 to 3 cm around the papilla. Although PAD is usually asymptomatic and discovered incidentally during endoscopic retrograde cholangiopancreatography (ERCP), it is associated with different pathological conditions such as common bile duct obstruction, pancreatitis, perforation, bleeding, and rarely carcinoma. ERCP has a low rate of success in patients with PAD, suggesting that this condition may complicate the technical application of the ERCP procedure. Moreover, cannulation of PAD can be challenging, time consuming, and require the higher level of skill of more experienced endoscopists. A large portion of the failures of cannulation in patients with PAD can be attributed to inability of the endoscopist to detect the papilla. In cases where the papilla is identified but does not point in a suitable direction for cannulation, different techniques have been described. Endoscopists must be aware of papilla identification in the presence of PAD and of different cannulation techniques, including their technical feasibility and safety, to allow for an informed decision and ensure the best outcome. Herein, we review the literature on this practical topic and propose an algorithm to increase the success rate of biliary cannulation. PMID:27014423

  18. Radiation dose to patients during endoscopic retrograde cholangiopancreatography

    PubMed Central

    Boix, Jaume; Lorenzo-Zúñiga, Vicente

    2011-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is an important tool for the diagnosis and treatment of the hepatobiliary system. The use of fluoroscopy to aid ERCP places both the patient and the endoscopy staff at risk of radiation-induced injury. Radiation dose to patients during ERCP depends on many factors, and the endoscopist cannot control some variables, such as patient size, procedure type, or fluoroscopic equipment used. Previous reports have demonstrated a linear relationship between radiation dose and fluoroscopy duration. When fluoroscopy is used to assist ERCP, the shortest fluoroscopy time possible is recommended. Pulsed fluoroscopy and monitoring the length of fluoroscopy have been suggested for an overall reduction in both radiation exposure and fluoroscopy times. Fluoroscopy time is shorter when ERCP is performed by an endoscopist who has many years experience of performing ERCP and carried out a large number of ERCPs in the preceding year. In general, radiation exposure is greater during therapeutic ERCP than during diagnostic ERCP. Factors associated with prolonged fluoroscopy have been delineated recently, but these have not been validated. PMID:21860683

  19. Acute pulmonary embolism during an endoscopic retrograde cholangiopancreatography.

    PubMed

    Painter, Nate P; Kumar, Priya A; Arora, Harendra

    2014-01-01

    A 76-year-old female patient presented for an endoscopic retrograde cholangiopancreatography (ERCP) for the removal of a biliary stent and lithotripsy. During the procedure, an acute drop in the end-tidal CO 2 , followed by cardiovascular collapse prompted the initiation of the advanced cardiac life support protocol. Transesophageal echocardiography (TEE) demonstrated direct evidence of pulmonary embolism. The patient was promptly treated with thrombolytic therapy and subsequently discharged home on oral warfarin therapy, with no noted sequelae. Although, there have been case reports of air embolism during an ERCP presenting with cardiovascular collapse, to the best of our knowledge, there are no reported cases of acute pulmonary embolus during this procedure. While the availability of TEE in the operating suites is quite common, quick access and interpretation capabilities in remote locations may not be as common. With the expansion of anesthesia services outside of the operating rooms, it may be prudent to develop rapid response systems that incorporate resources such as TEE and trained personnel to deal with such emergent situations. PMID:24732617

  20. Combination treatment of transjugular retrograde obliteration and endoscopic embolization for portosystemic encephalopathy with esophageal varices.

    PubMed

    Chikamori, Fumio; Kuniyoshi, Nobutoshi; Shibuya, Susumu; Takase, Yasuhiro

    2004-01-01

    The treatment of chronic portosystemic encephalopathy with esophageal varices has not yet been established. We were able to control a case of chronic portosystemic encephalopathy with esophageal varices using a combination treatment of transjugular retrograde obliteration and endoscopic embolization. A 57-year-old man came to our hospital in a confused, apathetic and tremulous state. The grade of encephalopathy was II. The plasma ammonia level was abnormally elevated to 119 microg/dL, and the ICGR15 was 59%. Endoscopic examination revealed nodular esophageal varices with cherry-red spots. There were no gastric varices. Ultrasonography and CT revealed liver cirrhosis with a splenorenal shunt. We first applied endoscopic embolization for the esophageal varices before transjugular retrograde obliteration. We injected 5% ethanolamine oleate with iopamidol retrogradely into the esophageal varices and their associated blood routes under fluoroscopy and obliterated the palisade vein, the cardiac venous plexus and left gastric vein. Transjugular retrograde obliteration was performed 14 days after endoscopic embolization. Retrograde shunt venography visualized the splenorenal shunt and communicating route to the retroperitoneal vein. There was no communicating route to the azygos vein. After obliteration of the communicating route to the retroperitoneal vein with absolute ethanol, 5% ethanolamine oleate with iopamidol was injected into the splenorenal shunt as far as the root of the posterior gastric vein. After transjugular retrograde obliteration, the encephalopathy improved to grade 0 even without the administration of lactulose and branched-chain amino acid. The plasma ammonia level and ICGR15 were reduced to 62 microg/dL and 26%. We conclude that combination treatment of transjugular retrograde obliteration and endoscopic embolization is a rational, effective and safe treatment for chronic portosystemic encephalopathy complicated with esophageal varices. PMID:15362757

  1. Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication.

    PubMed

    Markin, Nicholas W; Montzingo, Candice R

    2015-04-01

    Air embolism during endoscopic retrograde cholangiopancreatography is a rare but potentially fatal complication. A 66-year-old man underwent endoscopic retrograde cholangiopancreatography and remained stable until the end of the procedure, when he was found to have mottling on his right side and became hypoxic and unresponsive. Transesophageal echocardiography showed air within the left ventricle, consistent with systemic air embolism. Mortality resulted from significant cardiac and cerebral ischemia. The literature suggests that capnography is helpful in early diagnosis of air embolus, but it could not be used in this case because the patient's trachea was not intubated. PMID:25827860

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

    PubMed Central

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

    2016-01-01

    AIM: To assess pediatric patients for choledocholithiasis. We applied current adult guidelines to identify predictive factors in children. METHODS: A single-center retrospective analysis was performed at a tertiary children’s hospital. We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography (ERCP) for suspected choledocholithiasis. Patients were stratified into those with common bile duct stones (CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines (Very Strong and Strong criteria) for suspected CBDS. RESULTS: CBDS were identified in 84% at the time of ERCP. Abdominal ultrasound identified CBDS in 36% of patients. Conjugated bilirubin ≥ 0.5 mg/dL was an independent risk factor for CBDS (P = 0.003). The Very Strong (59.5%) and Strong (48.6%) ASGE criteria identified the majority of patients (P = 0.0001). A modified score using conjugated bilirubin had a higher sensitivity (81.2% vs 59.5%) and more likely to identify a stone than the standard criteria, odds ratio of 25.7 compared to 8.8. Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25, respectively. CONCLUSION: Current adult guidelines identified the majority of pediatric patients with CBDS, but specific pediatric guidelines may improve detection, thus decreasing risks and unnecessary procedures. PMID:27298714

  3. The Role of Endoscopic Retrograde Cholangiopancreatography in Management of Pancreatic Diseases.

    PubMed

    Riff, Brian P; Chandrasekhara, Vinay

    2016-03-01

    Endoscopic retrograde cholangiopancreatography is an effective platform for a variety of therapies in the management of benign and malignant disease of the pancreas. Over the last 50 years, endotherapy has evolved into the first-line therapy in the majority of acute and chronic inflammatory diseases of the pancreas. As this field advances, it is important that gastroenterologists maintain an adequate knowledge of procedure indication, maintain sufficient procedure volume to handle complex pancreatic endotherapy, and understand alternate approaches to pancreatic diseases including medical management, therapy guided by endoscopic ultrasonography, and surgical options. PMID:26895680

  4. Laparoscopy assisted transjejunal endoscopic retrograde cholangiography for treatment of intrahepatic duct stones in a post Roux-en-Y patient.

    PubMed

    Mansor, Salah M; Abdalla, Salem I; Bendardaf, Rashed S

    2015-01-01

    We report a case of a 17-year-old female patient, who was operated on for choledocal cyst with Roux-en Y hepatojejunostomy. She was admitted to hospital with recurrent attacks of acute ascending cholangitis due to left intrahepatic duct stones. After a failed attempt at conventional endoscopic retrograde cholangiopancreatography through the anatomical route, she was treated successfully with laparoscopy assisted transjejunal endoscopic retrograde cholangiography.  PMID:25630013

  5. Laparoscopy assisted transjejunal endoscopic retrograde cholangiography for treatment of intrahepatic duct stones in a post Roux-en-Y patient

    PubMed Central

    Mansor, Salah M.; Abdalla, Salem I.; Bendardaf, Rashed S.

    2015-01-01

    We report a case of a 17-year-old female patient, who was operated on for choledocal cyst with Roux-en Y hepatojejunostomy. She was admitted to hospital with recurrent attacks of acute ascending cholangitis due to left intrahepatic duct stones. After a failed attempt at conventional endoscopic retrograde cholangiopancreatography through the anatomical route, she was treated successfully with laparoscopy assisted transjejunal endoscopic retrograde cholangiography. PMID:25630013

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

    PubMed Central

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

    2014-01-01

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

  7. Endoscopic management of hilar biliary strictures

    PubMed Central

    Singh, Rajiv Ranjan; Singh, Virendra

    2015-01-01

    Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345

  8. Endoscopic management of hilar biliary strictures.

    PubMed

    Singh, Rajiv Ranjan; Singh, Virendra

    2015-07-10

    Hilar biliary strictures are caused by various benign and malignant conditions. It is difficult to differentiate benign and malignant strictures. Postcholecystectomy benign biliary strictures are frequently encountered. Endoscopic management of these strictures is challenging. An endoscopic method has been advocated that involves placement of increasing number of stents at regular intervals to resolve the stricture. Malignant hilar strictures are mostly unresectable at the time of diagnosis and only palliation is possible.Endoscopic palliation is preferred over surgery or radiological intervention. Magnetic resonance cholangiopancreaticography is quite important in the management of these strictures. Metal stents are superior to plastic stents. The opinion is divided over the issue of unilateral or bilateral stenting.Minimal contrast or no contrast technique has been advocated during endoscopic retrograde cholangiopancreatography of these patients. The role of intraluminal brachytherapy, intraductal ablation devices, photodynamic therapy, and endoscopic ultrasound still remains to be defined. PMID:26191345

  9. Measures of patient radiation exposure during endoscopic retrograde cholangiography: Beyond fluoroscopy time

    PubMed Central

    Kachaamy, Toufic; Harrison, Edwyn; Pannala, Rahul; Pavlicek, William; Crowell, Michael D; Faigel, Douglas O

    2015-01-01

    AIM: To determine whether fluoroscope time is a good predictor of patient radiation exposure during endoscopic retrograde cholangiopancreatography. METHODS: This is a prospective observational study of consecutive patients undergoing endoscopic retrograde cholangiopancreatography in a tertiary care setting. Data related to radiation exposure were collected. The following measures were obtained: Fluoroscopy time (FT), dose area product (DAP) and dose at reference point (DOSERP). Coefficients of determination were calculated to analyze the correlation between FT, DAP and DOSRP. Agreement between FT and DAP/DOSRP was assessed using Bland Altman plots. RESULTS: Four hundred sixty-three data sets were obtained. Fluoroscopy time average was 7.3 min. Fluoroscopy related radiation accounted for 86% of the total DAP while acquisition films related radiation accounted for 14% of the DAP. For any given FT there are wide ranges of DAP and DOSERP and the variability in both increases as fluoroscopy time increases. The coefficient of determination (R2) on the non transformed data for DAP and DOSERP versus FT were respectively 0.416 and 0.554. While fluoroscopy use was the largest contributor to patient radiation exposure during endoscopic retrograde cholangiography (ERCP), there is a wide variability in DAP and DOSERP that is not accounted for by FT. DAP and DOSERP increase in variability as FT increases. This translates into poor accuracy of FT in predicting DAP and DOSERP at higher radiation doses. CONCLUSION: DAP and DOSERP in addition to FT should be adopted as new ERCP quality measures to estimate patient radiation exposure. PMID:25684958

  10. Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique

    PubMed Central

    Bertolini, Reto; Meyenberger, Christa; Putora, Paul Martin; Albrecht, Franziska; Broglie, Martina Anja; Stoeckli, Sandro J; Sulz, Michael Christian

    2016-01-01

    AIM: To investigate the combined antegrade-retrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome. METHODS: This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation (CARD) within the last 10 years. The patients’ demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy (PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale (FOIS) (≥ level 3). RESULTS: The cohort consisted of six patients [five males; mean age 71 years (range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up (median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing (two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery. CONCLUSION: The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow. PMID:26900299

  11. Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

    PubMed Central

    Shimatani, Masaaki; Takaoka, Makoto; Tokuhara, Mitsuo; Miyoshi, Hideaki; Ikeura, Tsukasa; Okazaki, Kazuichi

    2015-01-01

    The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy (SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy (DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of single-balloon endoscopy (SBE) and spiral endoscopy (SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices. PMID:26078830

  12. Immediate detection of endoscopic retrograde cholangiopancreatography-related periampullary perforation: Fluoroscopy or endoscopy?

    PubMed Central

    Motomura, Yasuaki; Akahoshi, Kazuya; Gibo, Junya; Kanayama, Kenji; Fukuda, Shinichiro; Hamada, Shouhei; Otsuka, Yoshihiro; Kubokawa, Masaru; Kajiyama, Kiyoshi; Nakamura, Kazuhiko

    2014-01-01

    AIM: To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography (ERCP)-related perforations to support immediate or early diagnosis. METHODS: Consecutive patients who underwent ERCP procedures at our hospital between January 2008 and June 2013 were retrospectively enrolled in the study (n = 2674). All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation. For patients showing alterations in the gastrointestinal anatomy, a short-type double balloon enteroscope had been applied. Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitoneal space, or upon endoscopic detection of an abdominal cavity related to the perforated lumen. For patients with ERCP-related perforations, the data on medical history, endoscopic findings, radiologic findings, diagnostic methods, management, and clinical outcomes were used for descriptive analysis. RESULTS: Of the 2674 ERCP procedures performed during the 71-mo study period, only six (0.22%) resulted in perforations (male/female, 2/4; median age: 84 years; age range: 57-97 years). The cases included an endoscope-related duodenal perforation, two periampullary perforations related to endoscopic sphincterotomy, two periampullary perforations related to endoscopic papillary balloon dilation, and a periampullary or bile duct perforation secondary to endoscopic instrument trauma. No cases of guidewire-related perforation occurred. The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation; the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively (at a median post-ERCP intervention time of 15 min). Three out of the six total perforation cases, including the single case of endoscope-related duodenal injury, were surgically treated; the remaining three cases were

  13. [Intraparenchymal hepatic haematoma after endoscopic retrograde cholangiopancreotography overinfected by Citrobacter freundii and Klebsiella pneumoniae BLEE].

    PubMed

    Carrica, Sebastián A; Belloni, Rodrigo; Baldoni, Fernando; Yantorno, Martín; Correa, Gustavo; Bologna, Adrián; Barbero, Rodolfo; Villaverde, Augusto; Chopita, Néstor

    2014-06-01

    This case report describes a 37-year-old woman who develops an intraparenchymal hepatic haematoma after an endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction. The procedure requires the passage of a guidewire. The patient develops acute abdominal pain 72 hours later and a magnetic resonance shows a hematoma of 124 x 93 mm. She remains under observation. Twenty one days later she complains of upper right abdominal pain and fever. Consequently, a percutaneous drainage is performed isolating Citrobacter freundii and Klebsiella pneumoniae BLEE. The patient has a good evolution. PMID:25199307

  14. Using balloon-overtube-assisted enteroscopy for postoperative endoscopic retrograde cholangiopancreatography

    PubMed Central

    Skinner, Matthew; Velázquez-Aviña, Jacobo

    2014-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is technically more challenging in patients with postsurgical anatomy such as Roux-en-Y anastomosis, frequently mandating an operative intervention. Although limited, there is growing evidence that ERCP can be performed using the balloon-overtube-assisted enteroscopy (BOAE) in patients with complex postoperative anatomy. We present the technical aspects of performing ERCP with the BOAE in patients presenting with complex postsurgical anatomy having biliary problems. ERCP using the BOAE is feasible in patients with complex postsurgical anatomy, permitting diagnostic and therapeutic interventions in 80% of patients. PMID:25364385

  15. Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review

    PubMed Central

    Zappa, Marco Antonio; Aiolfi, Alberto; Antonini, Ilaria; Musolino, Cinzia Domenica; Porta, Andrea

    2016-01-01

    Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients’ haemodynamic and clinic. PMID:27158211

  16. Subcapsular hepatic haematoma of the right lobe following endoscopic retrograde cholangiopancreatography: Case report and literature review.

    PubMed

    Zappa, Marco Antonio; Aiolfi, Alberto; Antonini, Ilaria; Musolino, Cinzia Domenica; Porta, Andrea

    2016-05-01

    Sub capsular hepatic haematoma is a rare complication after endoscopic retrograde cholangiopancreatography (ERCP). Exact pathological mechanism is still unclear and few reports are nowadays available in literature. We report the case of a 58-year-old woman with recurrent episodes of upper abdominal pain, nausea and vomiting. On the basis of laboratory exams, abdomen ultrasound and magnetic resonance imaging she was diagnosed with a common bile duct stone. Endoscopic biliary sphincterotomy was performed. On the following day the patient complaint severe abdominal pain with rebound and hemodynamic instability. A computed tomography scan reveal a 14 cm × 6 cm × 19 cm sub-capsular hepatic haematoma on the right lobe that was successfully managed via percutaneous embolization. Sub capsular liver haematoma is a rare life threatening complication after ERCP that should be managed according to patients' haemodynamic and clinic. PMID:27158211

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

    PubMed

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

    2014-11-16

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period. PMID:25400872

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

    PubMed Central

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

    2014-01-01

    This study reports a 69-year-old, obese, female patient presenting with a biliary leakage after laparoscopic cholecystectomy for cholelithiasis. Closure of the umbilical trocar site had been neglected during the laparoscopic cholecystectomy. Early, on postoperative day five, endoscopic retrograde cholangiopancreatography (ERCP) requirement after laparoscopic cholecystectomy resolved the biliary leakage problem but resulted with a more complicated clinical picture with an intestinal obstruction and severe abdominal pain. Computed tomography revealed a strangulated hernia from the umbilical trocar site. Increased abdominal pressure during ERCP had strained the weak umbilical trocar site. Emergency surgical intervention through the umbilicus revealed an ischemic small bowel segment which was treated with resection and anastomosis. This report demonstrates that negligence of trocar site closure can result in very early herniation, particularly if an endoscopic intervention is required in the early postoperative period. PMID:25400872

  19. Sudden Death After Endoscopic Retrograde Cholangiopancreatography (ERCP)—Case Report and Literature Review

    PubMed Central

    Hauser, Goran; Milosevic, Marko; Zelić, Marko; Stimac, Davor

    2014-01-01

    Abstract There are only a few cases found in literature regarding air embolism in endoscopic procedures, especially in connection to endoscopic retrograde cholangiopancreatography (ERCP). We are presenting a case of a 56-year-old female patient who suffered from non-Hodgkin lymphoma located in her right groin. She was also diagnosed with choledocholithiasis and underwent ERCP to remove the gallstones. Immediately after the procedure she went into sudden cardiac arrest and subsequently died, despite all of our efforts. We reviewed literature in order to identify possible causes of death because fatal outcome following an uneventful and successful procedure was not expected. It is important to bear in mind all possible complications of ERCP. Our focus during the literature search was on air embolism. PMID:25501087

  20. Bile duct injury after laparoscopic cholecystectomy: the value of endoscopic retrograde cholangiopancreatography.

    PubMed Central

    Davids, P H; Ringers, J; Rauws, E A; de Wit, L T; Huibregtse, K; van der Heyde, M N; Tytgat, G N

    1993-01-01

    This study describes the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with bile duct injury after laparoscopic cholecystectomy. Twelve consecutive patients were studied over a one year period. In all patients the biliary tree was visualised during ERCP. Four patients had complete bile duct obstruction, seven patients had a stricture (two with concomitant leakage), and one patient had leakage from a hepatic branch. Three patients with complete obstruction, presented with a relatively prolonged symptom free, 'silent' period before diagnosis. In all four patients with complete transection, a proximal hepaticojejunostomy was performed. In one patient with a tough fibrous stricture, secondary to incorrect clip placement, passage of the guidewire was impossible, leaving surgical reconstruction as the only therapeutic option. All remaining seven patients with leakage or strictures, or both were successfully treated by endoscopic sphincterotomy only (n = 1) or sphincterotomy and subsequent stent placement (n = 6). When patients do not recover uneventfully after laparoscopic cholecystectomy even without cholestasis or jaundice, early ERCP is recommended as a safe and valuable method to detect bile duct injury and to suggest treatment. Subsequently, more than half of such patients can be treated endoscopically. Extended follow up is needed to evaluate the longterm results. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:8406163

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

    PubMed

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

    2016-01-01

    Fatal air embolism related to endoscopic retrograde cholangiopancreatography is a very rare phenomenon. The authors describe the case of a 51-year-old female patient who developed this mortal complication; a computed tomography (CT) examination was performed in articulo mortis by the physicians. Autopsy was unreliable because of bizarre post-mortem changes (reabsorption of intra-cardiac gas vs. conservation of intra-cranial gas) and a lack of strong diagnostic value of histological findings. The right diagnosis was possible thanks only to the CT examination that permitted the assumption of this possible cause of death before the autopsy and to prepare the necessary procedures to recognise and probe air embolism. This case exemplifies how early post-mortem imaging can be crucial to avoid a wrong diagnosis. PMID:26209631

  2. Refinement of canine pancreatitis model: inducing pancreatitis by using endoscopic retrograde cholangiopancreatography.

    PubMed

    Ruben, Dawn S; Scorpio, Diana G; Gabrielson, K L; Simon, B W; Buscaglia, Jonathan M

    2009-02-01

    The causes and treatments of pancreatitis have been studied in diverse species, but the canine pancreatitis model has been used most often due to its similarities to the condition in humans. Although pancreatitis in dogs can be induced readily by numerous methods, managing these dogs can be difficult because they often develop severe abdominal pain, vomiting, inappetance, and lethargy. In an effort to study pancreatitis, we performed a pilot study to determine whether an endoscopic pancreatic procedure would be possible in a dog and whether, through various manipulations, a new method of inducing pancreatitis could be developed. The model uses endoscopic retrograde cholangiopancreatography (ERCP), a common procedure in human gastroenterology that has been associated with postprocedural pancreatitis. Although all 8 dogs used in developing the ERCP model had both biochemical and histologic changes consistent with pancreatitis, 7 of the 8 dogs remained free of classic clinical signs of the disease. This method is presented as a refinement of a canine model and presents an alternative method of inducing pancreatitis, with decreased risk of developing associated clinical signs. PMID:19295057

  3. Is rectal indomethacin effective in preventing of post-endoscopic retrograde cholangiopancreatography pancreatitis?

    PubMed Central

    Döbrönte, Zoltán; Szepes, Zoltán; Izbéki, Ferenc; Gervain, Judit; Lakatos, László; Pécsi, Gyula; Ihász, Miklós; Lakner, Lilla; Toldy, Erzsébet; Czakó, László

    2014-01-01

    AIM: To investigate the effectiveness of rectally administered indomethacin in the prophylaxis of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and hyperamylasaemia in a multicentre study. METHODS: A prospective, randomised, placebo-controlled multicentre study in five endoscopic units was conducted on 686 patients randomised to receive a suppository containing 100 mg indomethacin, or an inert placebo, 10-15 min before ERCP. Post-ERCP pancreatitis and hyperamylasaemia were evaluated 24 h following the procedure on the basis of clinical signs and laboratory parameters, and computed tomography/magnetic resonance imaging findings if required. RESULTS: Twenty-one patients were excluded because of incompleteness of their data or because of protocol violation. The results of 665 investigations were evaluated: 347 in the indomethacin group and 318 in the placebo group. The distributions of the risk factors in the two groups did not differ significantly. Pancreatitis developed in 42 patients (6.3%): it was mild in 34 (5.1%) and severe in eight (1.2%) cases. Hyperamylaesemia occurred in 160 patients (24.1%). There was no significant difference between the indomethacin and placebo groups in the incidence of either post-ERCP pancreatitis (5.8% vs 6.9%) or hyperamylasaemia (23.3% vs 24.8%). Similarly, subgroup analysis did not reveal any significant differences between the two groups. CONCLUSION: 100 mg rectal indomethacin administered before ERCP did not prove effective in preventing post-ERCP pancreatitis. PMID:25110443

  4. Role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease

    PubMed Central

    Dolay, Kemal; Akbulut, Sami

    2014-01-01

    Most cases of hepatic hydatid disease exhibit uncomplicated clinical course and management. However, the diagnosis and management of complicated hepatic hydatid disease is a special issue. One of the most common and serious complications of hepatic hydatid disease is the rupture of the cyst into intrahepatic bile ducts. The clinical appearance of intrabiliary rupture can range from asymptomatic to jaundice, cholecystitis, cholangitis, liver abscess, pancreatitis and septicemia. Current treatments for major ruptures can result in high morbidity and mortality rates. Furthermore, ruptures that cannot be diagnosed preoperatively can induce complications such as biliary fistulae, biloma, cavitary infection and obstructive jaundice. In the past, these complications were diagnosed and treated by surgical methods. Currently, complications in both the pre- and postoperative periods are diagnosed and treated by non-invasive or minimally invasive methods. In clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) is indicated for patients with preoperative frank intrabiliary rupture in which hydatid elements are clearly seen in the bile ducts, or for biliary adverse events after surgery, including persistent biliary fistulae and jaundice. However, controversy concerning routine preoperative ERCP and prophylactic endoscopic sphincterotomy in patients suspected of having minor cystobiliary communications still remains. In this article, the role of ERCP in the diagnosis and management of hepatic hydatid disease during the pre- and postoperative periods is reviewed. PMID:25386073

  5. Evidence-Based Selection of Sedation Agents for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.

    PubMed

    Smith, Angela; Silvestro, Loraine; Rodriguez, Ricardo E; Austin, Paul N

    2016-01-01

    Sedating patients undergoing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) is challenging for the endoscopy team. Considering these challenges and concerns with the use of propofol for deep sedation of older adults and high-risk patients, colleagues of one of the authors (AS) were interested in the identification of techniques for the anesthetic management of subjects undergoing therapeutic ERCP. A search strategy revealed a total of 7 evidence sources. The appraised evidence examined the efficacy and sedation-related effects of anesthesia regimens. Deep sedation with propofol was identified as the most commonly used anesthetic technique for subjects undergoing therapeutic ERCP. The sedation-related unwanted effects of propofol appear to be dose-related and occur more frequently in the high-risk and elderly populations. However, the data were inconclusive in identifying an ideal agent offering superior efficacy with fewer unwanted sedation-related effects. Providers should strongly consider the subject's age, history of coexisting illness, and the pharmacological effects of selected anesthetic agents when choosing an appropriate anesthetic technique. Larger randomized controlled studies are needed to identify risk factors associated with sedation-related complications and to identify alternative options for the anesthetic management of subjects undergoing ERCP. PMID:26825562

  6. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography

    PubMed Central

    Reinders, Jan Siert Kayitsinga; Gouma, Dirk Joan; Heisterkamp, Joos; Tromp, Ellen; van Ramshorst, Bert; Boerma, Djamila

    2013-01-01

    Background Endoscopic retrograde cholangiography (ERCP) with endoscopic sphincterotomy (ES) followed by a laparoscopic cholecystectomy (LC) is generally accepted as the treatment of choice for patients with choledochocystolithiasis who are eligible for surgery. Previous studies have shown that LC after ES is associated with a high conversion rate. The aim of the present study was to assess the complexity of LC after ES compared with standard LC for symptomatic uncomplicated cholecystolithiasis. Methods The study population consisted of two patient cohorts: patients who had undergone a previous ERCP with ES for choledocholithiasis (PES) and patients with cholecystolithiasis who had no previous intervention prior to LC (NPES). Results The PES group consisted of 93 patients and the NPES group consisted of 83 consecutive patients. Patients in the PES group had higher risks for longer [more than 65 min, odds ratio (OR) = 4.21 (95% confidence interval (CI) 1.79–9.91)] and more complex [higher than 6 points, on a 0–10 scale, OR 3.12 (95% CI 1.43–6.81)] surgery. The conversion rate in the PES and NPES group (6.5% versus 2.4%, respectively) and the complication rate (12.9% versus 9.6%, respectively) were not significantly different. Discussion A laparoscopic cholecystectomy after ES is lengthier and more difficult than in uncomplicated cholelithiasis and should therefore be performed by an experienced surgeon. PMID:23374364

  7. Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography

    PubMed Central

    Ona, Mel A.; Changela, Kinesh; Sadanandan, Swayamprabha; Jelin, Abraham; Anand, Sury; Duddempudi, Sushil

    2014-01-01

    Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy. PMID:25177368

  8. Immune dysfunction in patients with obstructive jaundice before and after endoscopic retrograde cholangiopancreatography

    PubMed Central

    Chowdhury, Abeed H.; Camara, Miguel; Martinez-Pomares, Luisa; Zaitoun, Abed M.; Eremin, Oleg; Aithal, Guruprasad P.

    2016-01-01

    This prospective observational study investigated monocyte cytokine responses to lipopolysaccharide (LPS) in patients with obstructive jaundice (OJ) before and after endoscopic biliary drainage. Dendritic cell (DC) subsets and their expression of co-stimulatory molecules were also studied. Forty patients with OJ and ten non-jaundiced patients with normal gastroscopy findings were recruited. Ten healthy volunteers provided control blood samples for immunological assays. Patients with OJ had blood and duodenal mucosa sampled at the time of endoscopic retrograde cholangiopancreatography (ERCP) and further blood sampled during the recovery phase. Monocyte cytokine responses to LPS, DC subsets and co-stimulatory molecule expression were compared with controls. Duodenal morphology and occludin expression were also assessed. Monocytes obtained before ERCP from jaundiced patients demonstrated reduced cytokine responses to endotoxin compared with controls (IL-1β: 2678 compared with 4631 pg/ml, P=0.04 and IL-6: 3442 compared with 6157 pg/ml, P=0.002). Monocytes from patients with malignancy had poorer responses to endotoxin than from those with benign OJ (IL-1β: 2025 compared with 3332 pg/ml, P=0.001). After ERCP, the secretion of inflammatory cytokines by monocytes obtained from jaundiced patients increased (IL-1β: 2150 compared with 2520 pg/ml, P=0.03 and IL-6: 2488 compared with 3250 pg/ml, P=0.01). Occludin expression (85 compared with 95%, P=0.004) and mean duodenal villus height (334 compared with 404 μm, P=0.03) were lower in jaundiced patients. Before biliary drainage, patients with OJ had a higher percentage of myeloid dendritic cells (mDCs) and greater mDC expression of CD40 (P=0.04) and CD86 (P=0.04). Monocytes from patients with OJ had lower proinflammatory cytokine secretion in response to LPS, an effect reversed following biliary drainage. PMID:27252406

  9. Immune dysfunction in patients with obstructive jaundice before and after endoscopic retrograde cholangiopancreatography.

    PubMed

    Chowdhury, Abeed H; Camara, Miguel; Martinez-Pomares, Luisa; Zaitoun, Abed M; Eremin, Oleg; Aithal, Guruprasad P; Lobo, Dileep N

    2016-09-01

    This prospective observational study investigated monocyte cytokine responses to lipopolysaccharide (LPS) in patients with obstructive jaundice (OJ) before and after endoscopic biliary drainage. Dendritic cell (DC) subsets and their expression of co-stimulatory molecules were also studied. Forty patients with OJ and ten non-jaundiced patients with normal gastroscopy findings were recruited. Ten healthy volunteers provided control blood samples for immunological assays. Patients with OJ had blood and duodenal mucosa sampled at the time of endoscopic retrograde cholangiopancreatography (ERCP) and further blood sampled during the recovery phase. Monocyte cytokine responses to LPS, DC subsets and co-stimulatory molecule expression were compared with controls. Duodenal morphology and occludin expression were also assessed. Monocytes obtained before ERCP from jaundiced patients demonstrated reduced cytokine responses to endotoxin compared with controls (IL-1β: 2678 compared with 4631 pg/ml, P=0.04 and IL-6: 3442 compared with 6157 pg/ml, P=0.002). Monocytes from patients with malignancy had poorer responses to endotoxin than from those with benign OJ (IL-1β: 2025 compared with 3332 pg/ml, P=0.001). After ERCP, the secretion of inflammatory cytokines by monocytes obtained from jaundiced patients increased (IL-1β: 2150 compared with 2520 pg/ml, P=0.03 and IL-6: 2488 compared with 3250 pg/ml, P=0.01). Occludin expression (85 compared with 95%, P=0.004) and mean duodenal villus height (334 compared with 404 μm, P=0.03) were lower in jaundiced patients. Before biliary drainage, patients with OJ had a higher percentage of myeloid dendritic cells (mDCs) and greater mDC expression of CD40 (P=0.04) and CD86 (P=0.04). Monocytes from patients with OJ had lower proinflammatory cytokine secretion in response to LPS, an effect reversed following biliary drainage. PMID:27252406

  10. Computed tomography, angiography, and endoscopic retrograde cholangiopancreatography in the nonoperative management of hepatic and splenic trauma.

    PubMed

    Delgado Millán, M A; Deballon, P O

    2001-11-01

    There is a marked trend toward nonoperative management of abdominal trauma. This has been possible thanks to the advances in imaging and interventional techniques. In this work we review in which way computed tomography (CT) abdominal scans, angiography, and endoscopic retrograde cholangiopancreatography (ERCP) can guide the nonoperative management of hepatic and splenic trauma. The CT abdominal scan with intravenous contrast is the "departure imaging" of choice for the nonoperative management of hepatic and splenic trauma in the hemodynamically stable patient. It is the most accurate test for detecting, defining, and characterizing these injuries, the associated hemoperitoneum, and other abdominal abnormalities (the hollow viscus injuries missed on the CT scan were detected by clinical parameters and had no negative consequences in the outcome). It has an accuracy of more than 95% for these injuries, but CT grading alone cannot decide which patient can be treated conservatively and which patient requires surgery. Its usefulness for follow-up seems challenging. Angiography can be therapeutic, thereby avoiding surgery (some report that angiography can be performed even in patients with active bleeding as damage control); if vessel injury, active bleeding or hemobilia are suspected on the basis of a CT scan in a stable patient, angiography should be carried out. ERCP should be performed in patients with suspected injury to the biliary tree, even with normal iminodiacetic acid radionuclide scanning (HIDA) if symptoms persist. A biliary stent can be placed. Indications for angiography and ERCP remain unclear. PMID:11760741

  11. Reduction of Radiation Doses to Patients and Staff During Endoscopic Retrograde Cholangiopancreatography

    PubMed Central

    Sulieman, Abdelmoneim; Paroutoglou, Georgios; Kapsoritakis, Andreas; Kapatenakis, Anargeyros; Potamianos, Spiros; Vlychou, Marianna; Theodorou, Kiki

    2011-01-01

    Background/Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a considerable radiation exposure for patients and staff. While optimization of the radiation dose is recommended, few studies have been published. The purpose of this study has been to measure patient and staff radiation dose, to estimate the effective dose and radiation risk using digital fluoroscopic images. Entrance skin dose (ESD), organ and effective doses were estimated for patients and staff. Materials and Methods: Fifty-seven patients were studied using digital X-ray machine and thermoluminescent dosimeters (TLD) to measure ESD at different body sites. Organ and surface dose to specific radiosensitive organs was carried out. The mean, median, minimum, third quartile and the maximum values are presented due to the asymmetry in data distribution. Results: The mean ESD, exit and thyroid surface dose were estimated to be 75.6 mGy, 3.22 mGy and 0.80 mGy, respectively. The mean effective dose for both gastroenterologist and assistant is 0.01 mSv. The mean patient effective dose was 4.16 mSv, and the cancer risk per procedure was estimated to be 2 × 10-5 Conclusion: ERCP with fluoroscopic technique demonstrate improved dose reduction, compared to the conventional radiographic based technique, reducing the surface dose by a factor of 2, without compromising the diagnostic findings. The radiation absorbed doses to the different organs and effective doses are relatively low. PMID:21196649

  12. Who experiences endoscopic retrograde cholangiopancreatography after laparoscopic cholecystectomy for symptomatic gallstone disease?

    PubMed Central

    Joo, Sun-Hyung; Cho, Sungsin; Han, Min-Soo

    2016-01-01

    Purpose Laparoscopic cholecystectomy (LC) has become a standard treatment of symptomatic gallstone disease. But, some patients suffer from retained common bile duct stones after LC. The aim of this study is to analyze the predicting factors associated with subsequent postoperative endoscopic retrograde cholangiopancreatography (ERCP) after LC. Methods We retrospectively reviewed a database of every LC performed between July 2006 and September 2012. We classify 28 patients who underwent ERCP within 6 months after LC for symptomatic gallstone disease as the ERCP group and 56 patients who underwent LC for symptomatic gallstone disease during same period paired by sex, age, underlying disease, operation history, and body mass index as the control group. To identify risk factor performing postoperative ERCP after LC, we compared admission route, preoperative biochemical liver function test, number of gall stones, gallstone size, adhesion around GB, wall thickening of GB, and existence of acute cholecystitis between the 2 groups. Results Admission route, preoperative AST, ALT, and ALP, stone size, longer operation time, and acute cholecystitis were identified as risk factors of postoperative ERCP in univariate analyses. But, longer operation time (P = 0.004) and acute cholecystitis (P = 0.048) were identified as independent risk factors of postoperative ERCP in multivariate analyses. Conclusion The patient who underwent ERCP after LC for symptomatic gallstone disease are more likely experienced longer operation time and acute cholecystitis than the patient who did not undergo ERCP after LC. PMID:27274506

  13. Evaluation of radiation doses in patient and medical staff during endoscopic retrograde cholangiopancreatography procedures.

    PubMed

    Seo, Deoknam; Kim, Kie Hwan; Kim, Jung-Su; Han, Seonggyu; Park, Kyung; Kim, Jungmin

    2016-03-01

    The radiation exposure dose must be optimised because the hazard resulting from an interventional radiology procedure is long term depending on the patient. The aim of this study was to measure the radiation doses received by the patients and medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Data were collected during 126 ERCP procedures, including the dose-area product (DAP), entrance dose (ED), effective dose (E), fluoroscopy time (T) and number of digital radiographs (F). The medical staff members each wore a personal thermoluminescence dosemeter to monitor exposure during ERCP procedures. The mean DAP, ED, E and T were 47.06 Gy cm(2), 196.06 mGy, 8.93 mSv, 7.65 min and 9.21 images, respectively. The mean dose to the staff was 0.175 mSv and that to the assistant was 0.069 mSv. The dose to the medical staff was minimal when appropriate protective measures were used. The large variation in the patient doses must be further investigated. PMID:26269518

  14. Successful endoscopic hemostasis for ruptured duodenal varices after balloon-occluded retrograde transvenous obliteration.

    PubMed

    Soga, Koichi; Tomikashi, Koichi; Fukumoto, Kohei; Miyawaki, Ki-Ichirou; Okuda, Kotaro; Konishi, Hideyuki; Yagi, Nobuaki; Wakabayashi, Naoki; Kokura, Satoshi; Naito, Yuji; Yoshikawa, Toshikazu

    2010-10-01

    A 75-year-old man with general malaise and appetite loss was transferred to our hospital for assessment and treatment of liver failure. Laboratory findings on admission showed anemia, and gastroduodenoscopy (GDS) revealed linear esophageal varices and tensive duodenal varices (DV) in the second portion of the duodenum. Systemic examinations did not reveal any significant lesion capable of explaining his anemia, except for DV. Balloon-occluded retrograde transvenous obliteration was carried out to prevent DV bleeding. Good pooling of sclerosant was observed using two balloon catheters. However, contrast-enhanced computed tomography after the procedure revealed no thrombosis in DV, and the patient complained of tarry stools before additional therapy. Emergent GDS revealed ruptured DV with fresh blood and erosions on the surface. Emergent endoscopic obliteration using the tissue adhesive N-butyl-2-cyanoacrylate was carried out and complete hemostasis was achieved. Although no rebleeding episodes were observed after emergent obliteration, the patient died of sepsis following spontaneous bacterial peritonitis 53 days after admission. Autopsy revealed that DV dropped out, and the deep vein was replaced by granulation tissue. No signs of thrombi were detected, except varices. This autopsy case revealed the difficulty in DV management. PMID:21175490

  15. Adverse reactions to iodinated contrast media administered at the time of endoscopic retrograde cholangiopancreatography (ERCP).

    PubMed

    Pan, Jen-Jung; Draganov, Peter V

    2009-03-01

    Adverse reactions after intravascular administration of iodine contrast media are common and prophylactic regiments consisting of the use of steroids and low osmolality contrast media are highly effective in significantly decreasing the adverse reactions rate. The same type of contrast media are also used for opacification of the biliary tree and the pancreatic duct at the time of endoscopic retrograde cholangiopancreatography (ERCP). Systemic absorption of contrast media after ERCP routinely occurs. Although the adverse reaction rate appears to be very low the exact incidence remains unknown due to the retrospective nature of all reports. Despite the lack of formal recommendations, numerous prophylactic regiments are routinely used prior to ERCP in patients with history of prior reaction to intravascular contrast media. Moreover, the use of prophylaxis has even expanded to patients with no prior reaction to intravascular contrast media who are somehow perceived to be at increase risk (e.g. shellfish allergy). Recently, the first large scale prospective study reported exceedingly low incidence of adverse reaction to high oslmolality iodine-containing contrast media administered at the time of ERCP done without prophylactic premedication even in patients considered to be at the highest risk (prior severe reaction to intravascular contrast media administration). These data suggest that the use of prophylactic regiments prior to ERCP appears to be unnecessary. PMID:19275689

  16. Improved endoscopic retrograde cholangiopancreatography brush increases diagnostic yield of malignant biliary strictures

    PubMed Central

    Shieh, Frederick K; Luong-Player, Adelina; Khara, Harshit S; Liu, Haiyan; Lin, Fan; Shellenberger, Matthew J; Johal, Amitpal S; Diehl, David L

    2014-01-01

    AIM: To determine if a new brush design could improve the diagnostic yield of biliary stricture brushings. METHODS: Retrospective chart review was performed of all endoscopic retrograde cholangiopancreatography procedures with malignant biliary stricture brushing between January 2008 and October 2012. A standard wire-guided cytology brush was used prior to protocol implementation in July 2011, after which, a new 9 French wire-guided cytology brush (Infinity sampling device, US Endoscopy, Mentor, OH) was used for all cases. All specimens were reviewed by blinded pathologists who determined whether the sample was positive or negative for malignancy. Cellular yield was quantified by describing the number of cell clusters seen. RESULTS: Thirty-two new brush cases were compared to 46 historical controls. Twenty-five of 32 (78%) cases in the new brush group showed abnormal cellular findings consistent with malignancy as compared to 17 of 46 (37%) in the historical control group (P = 0.0003). There was also a significant increase in the average number of cell clusters of all sizes (21.1 vs 9.9 clusters, P = 0.0007) in the new brush group compared to historical controls. CONCLUSION: The use of a new brush design for brush cytology of biliary strictures shows increased diagnostic accuracy, likely due to improved cellular yield, as evidenced by an increase in number of cellular clusters obtained. PMID:25031790

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

    PubMed Central

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

    2011-01-01

    AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

  18. Surgical Success in Chronic Pancreatitis: Sequential Endoscopic Retrograde Cholangiopancreatography and Surgical Longitudinal Pancreatojejunostomy (Puestow Procedure).

    PubMed

    Ford, Kathryn; Paul, Anu; Harrison, Phillip; Davenport, Mark

    2016-06-01

    Introduction Chronic pancreatitis (CP) can be a cause of recurrent, severe, disabling abdominal pain in children. Surgery has been suggested as a useful therapy, although experience is limited and the results unpredictable. We reviewed our experience of a two-stage protocol-preliminary endoscopic retrograde cholangiopancreatography (ERCP) and duct stenting, and if symptoms resolved, definitive surgical decompression by longitudinal pancreatojejunostomy (LPJ) (Puestow operation). Patients and Methods This is a single-center, retrospective review of children with established CP who underwent an LPJ between February 2002 and September 2012. A questionnaire was completed (incorporating visual analog scale pain and lifestyle scores) to assess functional outcome. Data are expressed as median (range). Results In this study, eight (M:F ratio of 4:4) children underwent an LPJ and one female child had a more limited pancreatojejunostomy anastomosis following preliminary ERCP and stent placement where possible. Diagnoses included hereditary pancreatitis (n = 3), idiopathic or structural pancreatitis (n = 5), and duct stricture following radiotherapy (n = 1). Median duct diameter presurgery was 5 (4-11) mm. Endoscopic placement of a Zimmon pancreatic stent was possible in six with relief of symptoms in all. Median age at definitive surgery was 11 (range, 7-17) years with a median postoperative stay of 9 (range, 7-12) days and a follow-up of 6 (range, 0.5-12) years. All children reported markedly reduced episodes of pain postprocedure. One developed diabetes mellitus, while three had exocrine deficiency (fecal elastase < 200 µg/g) requiring enzyme supplementation. The child with limited LPJ had symptomatic recurrence and required restenting and further surgery to widen the anastomosis to become pain free. Conclusion ERCP and stenting provide a therapeutic trial to assess possible benefit of a definitive duct drainage procedure. LPJ-the modified Puestow

  19. Preliminary diagnostic reference levels for endoscopic retrograde cholangio-pancreatography in Greece.

    PubMed

    Tsapaki, V; Delinikolas, P; Paraskeva, K D; Paspatis, I A G; Scotiniotis, H; Georgopoulos, P; Voudoukis, E; Finou, P; Athanasopoulos, N; Lydakis, I; Giannakopoulos, A; Mathou, N; Angelogiannakopoulou, N; Triantopoulou, C; Karagiannis, J A

    2016-04-01

    The main objective of this study was to determine the preliminary Diagnostic Reference Levels (DRLs) in terms of Kerma Area Product (KAP) and fluoroscopy time (Tf) during Endoscopic Retrograde Cholangio-Pancreatography (ERCP) procedures. Additionally, an investigation was conducted to explore the statistical relation between KAP and Tf. Data from a set of 200 randomly selected patients treated in 4 large hospitals in Greece (50 patients per hospital) were analyzed in order to obtain preliminary DRLs for KAP and Tf during therapeutic ERCP procedures. Non-parametric statistic tests were performed in order to determine a statistically significant relation between KAP and Tf. The resulting third quartiles for KAP and Tf for hospitals (A, B, C and D) were found as followed: KAPA=10.7Gycm(2), TfA=4.9min; KAPB=7.5Gycm(2), TfB=5.0min; KAPC=19.0Gycm(2), TfC=7.3min; KAPD=52.4Gycm(2), TfD=15.8min. The third quartiles, calculated for the total 200 cases sample, are: KAP=18.8Gycm(2) and Tf=8.2min. For 3 out of 4 hospitals and for the total sample, p-values of statistical indices (correlation of KAP and Tf) are less than 0.001, while for the Hospital A p-values are ranging from 0.07 to 0.08. Using curve fitting, we finally determine that the relation of Tf and KAP is deriving from a power equation (KAP=Tf(1.282)) with R(2)=0.85. The suggested Preliminary DRLs (deriving from the third quartiles of the total sample) for Greece are: KAP=19Gycm(2) and Tf=8min, while the relation between KAP and Tf is efficiently described by a power equation. PMID:27068273

  20. Efficacy and safety of a patient-positioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography

    PubMed Central

    Lee, Seungho; Han, Joung-Ho; Lee, Hee Seung; Kim, Ki Bae; Lee, In-kwang; Cha, Eun-Jong; Shin, Young Duck; Park, Namgyu; Park, Seon Mee

    2015-01-01

    AIM: To assess the efficacy and safety of a patient-positioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: A total of 105 patients were randomized to the EZ-FIX (n = 53) or non-EZ-FIX (n = 52) group in this prospective study. Midazolam and propofol, titrated to provide an adequate level of sedation during therapeutic ERCP, were administered by trained registered nurses under endoscopist supervision. Primary outcome measures were the total dose of propofol and sedative-related complications, including hypoxia and hypotension. Secondary outcome measures were recovery time and sedation satisfaction of the endoscopist, nurses, and patients. RESULTS: There was no significant difference in the rate of hypoxia, but there was a statistical trend (EX-FIX group; n = 4, 7.55%, control group; n = 6, 11.53%, P = 0.06). The mean total dose of propofol was lower in the EZ-FIX group than in the non-EZ-FIX group (89.43 ± 49.8 mg vs 112.4 ± 53.8 mg, P = 0.025). In addition, the EZ-FIX group had a shorter mean recovery time (11.23 ± 4.61 mg vs 14.96 ± 5.12 mg, P < 0.001). Sedation satisfaction of the endoscopist and nurses was higher in the EX-FIX group than in the non-EZ-FIX group. Technical success rates of the procedure were 96.23% and 96.15%, respectively (P = 0.856). Procedure-related complications did not differ by group (11.32% vs 13.46%, respectively, P = 0.735). CONCLUSION: Using EZ-FIX reduced the total dose of propofol and the recovery time, and increased the satisfaction of the endoscopist and nurses. PMID:26019465

  1. Endoscopic retrograde cholangiopancreatography in patients with biliary complications after orthotopic liver transplantation: outcomes and complications.

    PubMed

    Sanna, C; Saracco, G M; Reggio, D; Moro, F; Ricchiuti, A; Strignano, P; Mirabella, S; Ciccone, G; Salizzoni, M

    2009-05-01

    Biliary complications after orthotopic liver transplantation (OLT) still remain a major cause of morbidity and mortality. The most frequent complications are strictures and leakages in OLT cases with duct-to-duct biliary reconstruction (D-D), which can be treated with dilatation or stent placement during endoscopic retrograde cholangiopancreatography (ERCP), although this procedure is burdened with potentially severe complications, such as retroperitoneal perforation, acute pancreatitis, septic cholangitis, bleeding, recurrence of stones, strictures due to healing process. The aim of the study was to analyze the outcome of this treatment and the complications related to the procedure. Among 1634 adult OLTs, we compared postprocedural complications and mortality rates with a group of 5852 nontransplanted patients (n-OLTs) who underwent ERCP. Of 472 (28,8%) post-OLT biliary complications, 319 (67.6%) occurred in D-D biliary anstomosis cases and 94 (29.5%) patients underwent 150 ERCP sessions. Among 49/80 patients (61.2%) who completed the procedure, ERCP treatment was successful. Overall complication rate was 10.7% in OLT and 12.8% in n-OLT (P = NS). Compared with the n-OLT group, post-ERCP bleeding was more frequent in OLT (5.3% vs 1.3%, P = .0001), while the incidence of pancreatitis was lower (4.7% vs 9.6%, P = .04). Procedure-related mortality rate was 0% in OLT and 0.1% in n-OLT (P = NS). ERCP is a safe procedure for post-OLT biliary complications in the presence of a D-D anastomosis. Morbidity and mortality related with this procedure are acceptable and similar to those among nontransplanted population. PMID:19460551

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

    PubMed Central

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

    2016-01-01

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

  3. Use of the Conventional Side-viewing Duodenoscope for Successful Endoscopic Retrograde Cholangiopancreatography in Postgastrectomy Patients

    PubMed Central

    Wu, Wen-Guang; Mei, Jia-wei; Zhao, Ming-Ning; Zhang, Wen-Jie; Gu, Jun; Tao, Yi-Jing; Liu, Ying-Bin

    2016-01-01

    Objectives: The aim of this study was to evaluate the usefulness of the conventional side-viewing duodenoscope for successful endoscopic retrograde cholangiopancreatography (ERCP) in postgastrectomy patients. Methods: A total of 220 consecutive patients with bile duct stones or a distal common bile duct stricture who had previously undergone gastrectomy and were referred for ERCP were analyzed for the outcome of their ERCP. All ERCP procedures were performed using a conventional side-viewing duodenoscope. In patients who had undergone a Billroth II gastroenterostomy and total gastrectomy with Roux-en-Y reconstruction, we also used the procedure of retrieval balloon–assisted enterography. Results: The study group included 220 patients who had previously undergone gastrectomy (77 women and 143 men; mean age, 72.2 y; range, 11 to 93 y). The overall enterography success rate was 90.5% (199/220), and the diagnostic and ERCP success rates were both 88.6% (195/220). Endoscopy was unsuccessful in 21 patients who received Billroth II gastroenterostomy and Roux-en-Y reconstruction. After successful endoscopy, diagnostic and ERCP success was not achieved in 4 patients with Billroth II gastroenterostomy, with or without Braun anastomosis, due to cannulation failure. The procedure-related complication rate was 5.5% (12/220), including immediate bleeding (0.9%, 2/220), pancreatitis (4.1%, 9/220), and perforation (0.5%, 1/220). There were no procedure-related deaths. Conclusions: The side-viewing duodenoscope is a useful instrument for performing successful ERCP in patients postgastrectomy. In addition, retrieval balloon–assisted enterography may improve the enterography success rate in postgastrectomy patients with Billroth II and Roux-en-Y reconstruction. PMID:26535481

  4. Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

    PubMed Central

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kikuchi, Hidehiko; Watanabe, Maya; Imaizumi, Hiroshi; Koizumi, Wasaburo

    2013-01-01

    AIM: To evaluate the effectiveness of a short-type single-balloon-enteroscope (SBE) for endoscopic retrograde cholangiopancreatography (ERCP) in patients with a reconstructed intestine. METHODS: Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed intestine. Short-type SBE is a direct-viewing endoscope with the following specifications: working length, 1520 mm; total length, 1840 mm; channel diameter, 3.2 mm. In addition, short-type SBE has a water-jet channel. The study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May 2012. Reconstruction was performed by Billroth-II (B-II) gastrectomy in 6 patients (8 sessions), Roux-en-Y (R-Y) gastrectomy in 14 patients (21 sessions), and R-Y hepaticojejunostomy in 2 patients (2 sessions). We retrospectively studied the rate of reaching the blind end (papilla of Vater or choledochojejunal anastomosis), mean time required to reach the blind end, diagnostic success rate (defined as the rate of successfully imaging the bile and pancreatic ducts), therapeutic success rate (defined as the rate of successfully completing endoscopic treatment), mean procedure time, and complications. RESULTS: Among the 31 sessions of ERCP, the rate of reaching the blind end was 88% in B-II gastrectomy, 91% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The mean time required to reach the papilla was 18.3 min in B-II gastrectomy, 21.1 min in R-Y gastrectomy, and 32.5 min in R-Y hepaticojejunostomy. The diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-II gastrectomy, 90% and 87% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. The therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-II gastrectomy, 94% and 92% in R-Y gastrectomy, and 100% in R-Y hepaticojejunostomy. Because the channel diameter was 3.2 mm, stone

  5. An extended fluorescence in situ hybridization approach for the cytogenetic study of cholangiocarcinoma on endoscopic retrograde cholangiopancreatography brushing cytology preparations.

    PubMed

    Vasilieva, Larisa E; Papadhimitriou, Stefanos I; Alexopoulou, Alexandra; Pavlidis, Dimitris; Kostopoulos, Ioannis; Georgiakaki, Maria; Xinopoulos, Dimitrios; Romanos, Andreas; Dourakis, Spyridon P

    2013-10-01

    The cytological diagnosis of cholangiocarcinoma has been significantly aided by applying a 4-probe fluorescence in situ hybridization system on endoscopic retrograde cholangiopancreatography brushing smears, aiming mainly at the detection of hyperdiploidy. However, this approach adds little to our understanding of the genetic background of the disease. With the prospect of obtaining additional data on chromosomal aberrations, we have extended the fluorescence in situ hybridization study, with the application of 4 independent 2-probe systems in 35 patients with documented cholangiocarcinoma. Fluorescence in situ hybridization assays were performed on endoscopic retrograde cholangiopancreatography brushing smears, with probes for the 7q31, 11q13 (CCND1), 17p53 (TP53), and 9p21 (INK4 locus) bands, together with the respective centromeric probe. Hyperdiploidy, involving at least 2 of the 4 chromosomes targeted, was found in 31 patients. 17p13 deletion was detected in 3, and 9p21 deletion, in 5 of the hyperdiploid cases, with the 2 aberrations concurrent in 1. CCND1 amplification was found in 1 case as the sole abnormality and in another together with hyperdiploidy, but in apparently unrelated clones. This work indicates that interphase fluorescence in situ hybridization is a practical and useful tool for the cytogenetic study of cholangiocarcinoma on endoscopic retrograde cholangiopancreatography brushing smears, which is often the only available tissue specimen of the tumor. Apart from hyperdiploidy, it provides additional data on the genetic profile of cholangiocarcinoma, especially regarding structural chromosomal aberrations and clonal diversity. This line of investigation may prove useful in the delineation of oncogenesis and the interpretation of the diverse clinical features of the disease. PMID:23845469

  6. Suppository naproxen reduces incidence and severity of post-endoscopic retrograde cholangiopancreatography pancreatitis: Randomized controlled trial

    PubMed Central

    Mansour-Ghanaei, Fariborz; Joukar, Farahnaz; Taherzadeh, Zahra; Sokhanvar, Homayoon; Hasandokht, Tolou

    2016-01-01

    AIM: To determine the efficacy of rectally administered naproxen for the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). METHODS: This double-blind randomized control trial conducted from January 2013 to April 2014 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 324 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients received a single dose of Naproxen (500 mg; n = 162) or a placebo (n = 162) per rectum immediately before ERCP. The overall incidence of PEP, incidence of mild to severe PEP, serum amylase levels and adverse effects were measured. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and elevation of the serum amylase level to > 3 × the upper normal limit (60-100 IU/L) within 24 h after ERCP. The severity of PEP was classified according to the duration of therapeutic intervention for PEP: mild, 2-3 d; moderate 4-10 d; and severe, > 10 d and/or necessitated surgical or intensive treatment, or contributed to death. RESULTS: PEP occurred in 12% (40/324) of participants, and was significantly more frequent in the placebo group compared to the naproxen group (P < 0.01). Of the participants, 25.9% (84/324) developed hyperamylasemia within 2 h of procedure completion, among whom only 35 cases belonged to the naproxen group (P < 0.01). The incidence of PEP was significantly higher in female sex, in patients receiving pancreatic duct injection, more than 3 times pancreatic duct cannulations, and ERCP duration more than 40 min (Ps < 0.01). There were no statistically significant differences between the groups regarding the procedures or factors that might increase the risk of PEP, sphincterotomy, precut requirement, biliary duct injection and number of pancreatic duct cannulations. In the subgroup of patients with pancreatic duct injection, the rate of pancreatitis in

  7. Endoscopic retrograde cholangiopancreatography in octogenarians: A population-based study using the nationwide inpatient sample

    PubMed Central

    Clark, Clancy J.; Coe, Adam; Fino, Nora F.; Pawa, Rishi

    2016-01-01

    Background and study aims: In the elderly population, there is a growing demand for minimally invasive procedures as the incidence of pancreaticobiliary disease increases with age. Patients with advanced age offer unique challenges for any procedure because they also tend to have a higher rate of baseline comorbidities and malignancy. The aim of the current study was to characterize the mortality and length of stay of octogenarians undergoing inpatient endoscopic retrograde cholangiopancreatography (ERCP). Patients and methods: Using the 2007 – 2010 Nationwide Inpatient Sample (NIS), we performed a retrospective analysis of health-related outcomes among 80- to 89-year-old patients undergoing inpatient ERCP. Surgical patients were excluded. Results: An estimated 61,322 octogenarians underwent inpatient ERCP in the United States from 2007 to 2010. The mean age was 84.2 (SE 0.02) with 59.5 % (n = 36,460) of the patients being female. A large majority of the patients were white (79. %, n = 41,144) and 63.5 % (n = 38,940) had a comorbidity index of at least 2. The mean length of stay was 7.1 days (SE 0.08) with an in-hospital mortality of 3.1 % (n = 1,919). The primary discharge diagnosis was most often biliary stone disease (55.9 %, n = 34,263). A diagnosis of any infection was recorded in 45.0 % (n = 27,609) of patients. Infection was associated with a significantly higher risk of in-hospital mortality (OR 3.3, 95 % CI 2.6 – 4.2, P < 0.001). Conclusions: ERCP is now routinely being performed during inpatient admissions for octogenarians with diseases of the biliary tract. The mortality of octogenarians undergoing inpatient ERCP is higher than previous reports and is likely due to superimposed infection during the same admission. PMID:27556068

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

    PubMed Central

    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

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

    PubMed

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

    2016-02-25

    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

  10. Pulseless electrical activity arrest due to air embolism during endoscopic retrograde cholangiopancreatography: a case report and review of the literature

    PubMed Central

    Mathew, Jacob; Parker, Calvin; Wang, James

    2015-01-01

    While most gastroenterologists are aware of the more common complications of endoscopy such as bleeding, infection and perforation, air embolism remains an under-recognised and difficult to diagnose problem due to its varying modes of presentation. This is the case of a 55-year-old man with right upper quadrant pain and imaging notable for cholecystitis and choledocholithiasis, who underwent endoscopic retrograde cholangiopancreatography (ERCP). During the ERCP, and shortly after a sphincterotomy was performed, he became hypotensive and hypoxic, quickly decompensating into pulseless electrical activity. While advanced cardiac life support was initiated, the patient passed away. Autopsy revealed air in the pulmonary artery suggestive of a pulmonary embolism. While air embolism remains a rare complication of upper endoscopy, increased awareness and prompt recognition of signs that may point to this diagnosis may potentially save lives by allowing for earlier possible interventions. PMID:26462286

  11. A Prospective Blinded Study Evaluating the Role of Endoscopic Ultrasound before Endoscopic Retrograde Cholangiopancreatography in the Setting of "Positive" Intraoperative Cholangiogram during Cholecystectomy.

    PubMed

    Luthra, Anjuli K; Aggarwal, Vipul; Mishra, Girish; Conway, Jason; Evans, John A

    2016-04-01

    During laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is used to identify common bile duct (CBD) stones. In patients whose IOC is suspicious for stones, endoscopic retrograde cholangiopancreatography (ERCP) is the modality of choice for stone removal. However, IOC has a false positive rate of 30 to 60 per cent, and ERCP adverse events may occur in 11 per cent of patients. Endoscopic ultrasound (EUS) may serve as a noninvasive means of diagnosing suspected CBD stones. This study sought to assess the role of EUS in predicting the likelihood of choledocholithiasis at ERCP in patients found to have a positive IOC. This was a prospective blinded study of EUS before ERCP in patients with a positive IOC. Recruited subjects who underwent cholecystectomy and had an IOC with suspicion for obstruction were referred for ERCP within one month of their procedure. In patients with a positive IOC, EUS had a positive predictive value of 95 per cent in detecting choledocholithiasis. IOC with single or multiple filling defects more often correlated to the presence of CBD stones. At ERCP, choledocholithiasis was present in 65 per cent of patients who had an IOC suspicious for CBD stones. EUS should be used as a noninvasive method to correctly identify retained CBD stones in low-to-moderate risk patients with a positive IOC. PMID:27097628

  12. Two Cases of Cerebral Air Embolism That Occurred during Esophageal Ballooning and Endoscopic Retrograde Cholangiopancreatography

    PubMed Central

    Park, Suyeon; Ahn, Ji Yong; Ahn, Young Eun; Jeon, Sang-Beom; Lee, Sang Soo; Jung, Hwoon-Yong; Kim, Jin-Ho

    2016-01-01

    Cerebral air embolism is an extremely rare complication of endoscopic procedure and often life threatening. We present two cases of cerebral infarction due to air embolization caused by an endoscopic intervention. The first case occurred during esophageal balloon dilatation for the treatment of a stricture of an anastomosis site in a 59-year-old man and the second case occurred during endoscopic papillary balloon dilatation in a 69-year-old man who had distal common bile duct stones. After the procedure, cardiopulmonary instability and altered mental status were observed in both patients, and cerebral air embolism was diagnosed in both cases. Hyperbaric oxygen therapy was started in the first case, and high FiO2 therapy was applied in the second case. Although this complication is rare, patient outcomes can be improved if physicians are aware of this potential complication, and immediately begin proper management. PMID:26898514

  13. Two Cases of Cerebral Air Embolism That Occurred during Esophageal Ballooning and Endoscopic Retrograde Cholangiopancreatography.

    PubMed

    Park, Suyeon; Ahn, Ji Yong; Ahn, Young Eun; Jeon, Sang-Beom; Lee, Sang Soo; Jung, Hwoon-Yong; Kim, Jin-Ho

    2016-03-01

    Cerebral air embolism is an extremely rare complication of endoscopic procedure and often life threatening. We present two cases of cerebral infarction due to air embolization caused by an endoscopic intervention. The first case occurred during esophageal balloon dilatation for the treatment of a stricture of an anastomosis site in a 59-year-old man and the second case occurred during endoscopic papillary balloon dilatation in a 69-year-old man who had distal common bile duct stones. After the procedure, cardiopulmonary instability and altered mental status were observed in both patients, and cerebral air embolism was diagnosed in both cases. Hyperbaric oxygen therapy was started in the first case, and high FiO2 therapy was applied in the second case. Although this complication is rare, patient outcomes can be improved if physicians are aware of this potential complication, and immediately begin proper management. PMID:26898514

  14. Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy.

    PubMed

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Imaizumi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Koizumi, Wasaburo

    2015-06-01

    Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy. PMID:26074685

  15. Innovations and techniques for balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

    PubMed Central

    Yamauchi, Hiroshi; Kida, Mitsuhiro; Imaizumi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Koizumi, Wasaburo

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) remains challenging in patients who have undergone surgical reconstruction of the intestine. Recently, many studies have reported that balloon-enteroscope-assisted ERCP (BEA-ERCP) is a safe and effective procedure. However, further improvements in outcomes and the development of simplified procedures are required. Percutaneous treatment, Laparoscopy-assisted ERCP, endoscopic ultrasound-guided anterograde intervention, and open surgery are effective treatments. However, treatment should be noninvasive, effective, and safe. We believe that these procedures should be performed only in difficult-to-treat patients because of many potential complications. BEA-ERCP still requires high expertise-level techniques and is far from a routinely performed procedure. Various techniques have been proposed to facilitate scope insertion (insertion with percutaneous transhepatic biliary drainage (PTBD) rendezvous technique, Short type single-balloon enteroscopes with passive bending section, Intraluminal injection of indigo carmine, CO2 inflation guidance), cannulation (PTBD or percutaneous transgallbladder drainage rendezvous technique, Dilation using screw drill, Rendezvous technique combining DBE with a cholangioscope, endoscopic ultrasound-guided rendezvous technique), and treatment (overtube-assisted technique, Short type balloon enteroscopes) during BEA-ERCP. The use of these techniques may allow treatment to be performed by BEA-ERCP in many patients. A standard procedure for ERCP yet to be established for patients with a reconstructed intestine. At present, BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as first-line treatment. In this article, we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy. PMID:26074685

  16. [A case of ruptured duodenal varices successfully treated by combination therapy with endoscopic clipping and balloon-occluded retrograde transvenous obliteration].

    PubMed

    Taniguchi, Hideaki; Shibagaki, Koutaro; Goto, Daisuke; Kakehi, Eiichi

    2015-11-01

    An 80-year-old woman with a history of chronic hepatitis B was referred to our hospital because of upper gastrointestinal bleeding of unknown origin. Dynamic computed tomography revealed liver cirrhosis and hepatofugal collateral vessels around the duodenum. Emergency esophagogastroduodenoscopy showed duodenal varices with an erosive spot, highly suggestive of a variceal rupture site. We immediately performed endoscopic clipping of the ruptured site to achieve temporary hemostasis. Ten days later, elective balloon-occluded retrograde transvenous obliteration (B-RTO) was performed to prevent recurrence. We describe a successfully treated case of duodenal variceal rupture managed by combination therapy with endoscopic clipping and B-RTO. PMID:26537327

  17. The impact of brush cytology from endoscopic retrograde cholangiopancreatography (ERCP) on patient management at a UK teaching hospital

    PubMed Central

    Sethi, Rajiv; Singh, Kaushiki; Warner, Ben; Mahadeva, Ula; Wilkinson, Mark

    2016-01-01

    Introduction Patients with suspected pancreaticobiliary cancers frequently undergo endoscopic retrograde cholangiopancreatography (ERCP) to obtain brush cytology for confirmatory diagnosis. The outcome of this often leads to the management of the patient and can avoid more invasive investigations. There is a wide range of sensitivities and specificities reported in the literature. Aims To determine the accuracy of the brush cytology obtained at ERCP by performing a retrospective audit of all patients admitted to Guy's and St. Thomas’ Hospital for ERCP during 2008–2013. Also, to evaluate the impact of cytology results on patient care following ERCP. Method Data were collected from 4 January 2008 to 27 December 2013. This involved analysing EndoSoft (the in-house software for endoscopic data entry), Pathnet (the pathology database) and Electronic Patient Records. Results 162 patients underwent brush cytology during ERCP. 58 patients had positive cytology. With intention-to-treat analysis, sensitivity was 54.7%, specificity was 100.0% and negative predictive value was 53.9% with a positive predictive value of 100%. Patients with a positive brush cytology result required fewer investigations compared with patients with a negative cytology result. Conclusions Our results compare favourably with previous studies in the field. Brush cytology has been ignored in recent times due to perceived poor results and efficacy. Our audit shows that it can reduce the number of investigations required to reach a diagnosis of malignancy and so is a valuable tool in the diagnosis of pancreaticobiliary malignancies. However, better guidance on preparation of samples for cytology is needed to reduce the number of insufficient samples. PMID:27103983

  18. Microbiological Assessment of Bile and Corresponding Antibiotic Treatment: A Strobe-Compliant Observational Study of 1401 Endoscopic Retrograde Cholangiographies.

    PubMed

    Rupp, Christian; Bode, Konrad; Weiss, Karl Heinz; Rudolph, Gerda; Bergemann, Janine; Kloeters-Plachky, Petra; Chahoud, Fadi; Stremmel, Wolfgang; Gotthardt, Daniel Nils; Sauer, Peter

    2016-03-01

    The aim of this study was to determine the antibiotic susceptibility profiles of bacteria in bile samples and to analyze the clinical relevance of the findings as only limited information about risk factors for elevated frequence of bacterial and fungal strains in routinely collected bile samples has been described so far.A prospective cohort study at a tertiary care center was conducted. Seven hundred forty-four patients underwent 1401 endoscopic retrograde cholangiographies (ERCs) as indicated by liver transplantation (427/1401), primary sclerosing cholangitis (222/1401), choledocholithiasis only (153/1401), obstruction due to malignancy (366/1401), or other conditions (233/1401). Bile samples for microbiological analysis were obtained in all patients.The 71.6% (823/1150) samples had a positive microbiological finding, and 57% (840/1491) of the bacterial isolates were gram-positive. The main species were Enterococcus spp (33%; 494/1491) and Escherichia coli (12%; 179/1491). Of the samples, 53.8% had enteric bacteria and 24.7% had Candida spp; both were associated with clinical and laboratory signs of cholangitis (C-reactive proteins 35.0 ± 50.1 vs 44.8 ± 57.6; 34.5 ± 51.2 vs 52.9 ± 59.7; P < 0.001), age, previous endoscopic intervention, and immunosuppression. Multi-resistant (MR) strains were found in 11.3% of all samples and were associated with clinical and laboratory signs of cholangitis, previous intervention, and immunocompromised status. In subgroup analysis, strain-specific antibiotic therapy based on bile sampling was achieved in 56.3% (89/158) of the patients. In cases with a positive bile culture and available blood culture, blood cultures were positive in 29% of cases (36/124), and 94% (34/36) of blood cultures had microbial species identical to the bile cultures.Bactobilia and fungobilia can usually be detected by routine microbiological sampling, allowing optimized, strain-specific antibiotic treatment. Previous endoscopic

  19. Evaluation of staff, patient and foetal radiation doses due to endoscopic retrograde cholangiopancreatography (ERCP) procedures in a pregnant patient.

    PubMed

    Huda, A; Garzón, W J; Filho, G C L; Vieira, B; Kramer, R; Xu, X G; Gao, Y; Khoury, H J

    2016-03-01

    The use of endoscopic retrograde cholangiopancreatography (ERCP) in pregnant patients is not rare. Most studies on the safety and efficacy of these procedures report short- and long-term pregnancy outcomes and but not foetal absorbed doses. This investigation reports on an ERCP procedure for a 40-y-old woman who was 32-34 weeks pregnant. Thermoluminescent dosemeters (TLD 100) were used to measure doses received by the patient and the staff. Additionally, Monte Carlo calculations were performed using a 3D computational phantom representing a 9-month pregnant patient to estimate the foetal absorbed dose. The results show that the spleen of the mother received the largest absorbed dose of 12.18 mGy since it was closer to the source than other internal organs. For the foetus and uterus, the lowest absorbed dose was found to be 0.01 mGy to the foetal brain, while the largest absorbed dose was estimated to be 0.13 mGy to the placenta. PMID:26084305

  20. [Thoracoabdominal CT scan: a useful tool for the diagnosis of air embolism during an endoscopic retrograde cholangiopancreatography].

    PubMed

    Tan, B K; Saunier, C-F; Cotton, F; Gueugniaud, P-Y; Piriou, V

    2008-03-01

    We report the case of an 82-year-old woman treated with biliary stents for an ampulloma of Vater's papilla, with recurrent stenosis of the common bile duct. She was hospitalized with a cholestasis. An endoscopic retrograde cholangiopancreatography (ERCP) was scheduled to change the biliary stent for a metallic one, under general anaesthesia, with oral intubation. The ERCP was performed initially without any complication, but as the metallic biliary stent was placed, an air embolism occurred and a cardiac arrest happened immediately. The etiologic diagnosis was quickly confirmed by an injected multislice body-scan, which showed liver, right heart and brain gas embolism. Cardiopulmonary resuscitation allowed a complete haemodynamic recovery but a poor neurological recovery. The patient was transferred in intensive care unit, were she died 12 days after, despite hyperbaric oxygen therapy and the disappearance of the air embolism on the following computed tomography scan. This case may be useful to recall the utility of a body-scan for the diagnosis, treatment and follow-up of an air embolism during ERCP. PMID:18313255

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

    PubMed Central

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

    2016-01-01

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

  2. The dexmedetomidine “augmented” sedato analgesic cocktail: An effective approach for sedation in prolonged endoscopic retrograde cholangio-pancreatography

    PubMed Central

    Mukhopadhyay, Sandip; Niyogi, Mausumi; Sarkar, Joydip; Mukhopadhyay, Basabdatta Samanta; Halder, Swapan Kumar

    2015-01-01

    Background and Aims: In absence of any published standard guideline for sedation or anesthesia practice for prolonged therapeutic “endoscopic retrograde cholangio-pancreatography (ERCP)”, safe and cost-effective sedation protocol is the need of the hour. Our study aims to evaluate the efficacy of a dexmedetomidine as an add-on for prolonged deep sedation for ERCP and to compare three deep sedation regimens regarding safety and efficacy. Material and Methods: Forty-five consecutively enrolled patients planned for therapeutic ERCP and assumed to have prolonged procedural duration (>50 min) were divided into three groups in a randomized assessor blinded fashion. Group 1 received propofol and midazolam, Group 2 received the sedato-analgesic cocktail containing ketamine-propofol-midazolam-pentazocine, and the Group 3 received sedate-analgesic cocktail plus dexmedetomidine infusion under monitoring of vital parameters and according to the judgment of the concerned anesthesiologist. Total propofol requirement, episodes of gagging, oxygen desaturation, changes in mean blood pressure (MBP), recovery and satisfaction score of endoscopist, anesthetist and patient were noted and analyzed statistically using one way ANOVA with Bonferroni correction and Chi-square test. Results: Mean propofol requirement, incidences of gagging and oxygen desaturation was significantly less in Group 2 and 3 compared to Group 1. MBP was more stable and recovery was faster in Group 3. Anesthetist's satisfaction was more with Group 2 and even more with Group 3. Conclusions: The sedato-analgesic cocktail was superior to the conventional propofol-midazolam regimen, dexmedetomidine as add-on increased the efficacy and safety of sedate-analgesic cocktail. It reduces propofol requirement, helps to maintain the patient in a safe and more stable level of sedation and increases satisfaction of the anesthetist. PMID:25948901

  3. Balloon-occluded retrograde transvenous obliteration versus endoscopic injection sclerotherapy for isolated gastric varices: a comparative study.

    PubMed

    Emori, Keigo; Toyonaga, Atsushi; Oho, Kazuhiko; Kumamoto, Masafumi; Haruta, Tsuyoshi; Inoue, Hiroto; Morita, Yukihiko; Mitsuyama, Keiichi; Tsuruta, Osamu; Sata, Michio

    2014-01-01

    Isolated gastric varices (IGV) have a lower risk of bleeding than esophageal varices, however IGV bleeding is associated with a higher mortality than bleeding of esophageal varices. In recent years, two widely used treatments for IGV have been balloon-occluded retrograde transvenous obliteration (B-RTO) and endoscopic injection sclerotherapy (EIS) using cyanoacrylate or ethanolamine oleate (EO). This study compared these two treatment methods for IGV. The subjects were 112 patients who were treated at our hospital for IGV bleeding between October 1990 and December 2003. Forty-nine (49) patients were treated with B-RTO and 63 patients with EIS. These two patient groups were compared as regards content of treatment, post-treatment incidence of variceal bleeding, incidence of IGV rebleeding, survival rate, cause of death, and complications. Multivariate analysis was performed on post-treatment variceal bleeding and survival. Although EO was used in higher amounts in the B-RTO group than in the EIS group, the B-RTO group had a significantly lower number of treatment sessions and a significantly shorter treatment period (p<0.05). The EIS group had significantly more patients with IGV rebleeding after treatment than the B-RTO group. Treatment method was the only independent prognostic factor of IGV bleeding after treatment (p=0.024). The two groups did not differ significantly in the percentage of patients with aggravated esophageal varices after treatment. Bleeding from ectopic varices was not observed in any patient. There was no significant difference in survival by treatment method. The presence of hepatocellular carcinoma was the only independent prognostic factor for survival (p=0.003). It is concluded that B-RTO was more effective than EIS in the eradication of IGV and prevention of IGV recurrence and rebleeding. PMID:24858411

  4. Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis by pancreatic duct stenting using a loop-tipped guidewire

    PubMed Central

    Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Jun-ichi; Sasaki, Reina; Kusakabe, Yuko; Nakamura, Masato; Yasui, Shin; Mikata, Rintaro; Miyazaki, Masaru; Yokosuka, Osamu

    2016-01-01

    AIM To examine whether it is possible to prevent the occurrence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis in patients experiencing difficulties with selective biliary duct cannulation by pancreatic duct stenting using a loop-tipped guidewire. METHODS Procedure success rate, frequency of unintended insertion of the guidewire into side branches of the pancreatic duct, and incidence of procedural accidents were examined using a loop-tipped guidewire (Group A, 20 patients), and a conventional straight-type guidewire (Group B, 20 patients). RESULTS The success rate of the procedure was 100% in both groups. Unintended insertion of the guidewire into a side branch of the pancreatic duct occurred 0.056 ± 0.23 (0-1) times in Group A and 2.3 ± 1.84 (0-5) times in Group B; thus, unintended insertion of the guidewire into a side branch of the pancreatic duct was seen significantly less frequently in Group A. There were no procedural accidents in Group A, whereas pancreatitis occurred in one Group B patient; however, the difference between the two groups was not statistically significant. The serum amylase level after ERCP was 257.15 ± 136.4 (88-628) IU/L in Group A, and 552.05 ± 534.57 (101-2389) IU/L in Group B, showing a significantly lower value in Group A. Hyperamylasemia was found in two patients (10%) in Group A, and nine (45%) in Group B, showing a significantly lower value in Group A. CONCLUSION The results suggest that in patients who experience difficulties with biliary cannulation, the use of a loop-tipped guidewire for pancreatic duct stenting may assist with the prevention of post-ERCP pancreatitis, and thereby to a reduction of the risk of post-ERCP pancreatitis or hyperamylasemia. PMID:27574608

  5. Effects of pinaverium bromide in the premedication of endoscopic retrograde cholangio-pancreatography and on motor activity of the sphincter of Oddi.

    PubMed

    Lamazza, A; Tofi, A; Bolognese, A; Fontana, B; De Masi, E; Frontespezi, S

    1986-01-01

    A double-blind study was carried out in 18 patients with biliary and pancreatic disease to assess the use of pinaverium bromide in premedication for endoscopic retrograde cholangio-pancreatography and its effects on motor activity of the sphincter of Oddi. Patients were divided at random into three groups. One group received 100 mg pinaverium bromide twice daily for 3 days before and then 100 mg 1 hour before the examination, the second group received placebo, and the third had no medication. All patients received 10 to 20 mg diazepam intravenously 10 minutes before endoscopy. Assessments were made of the transit time of various endoscopic phases and patients' tolerance of the procedure. The effects of treatment on the sphincter of Oddi were estimated by means of endoscopic manometry. The results showed that pinaverium bromide allowed transit time reduction in endoscopic procedure, a greater tolerance on the part of the patient and marked reduction in the amplitude and duration of the phasic activity of the sphincter. PMID:3780291

  6. Role of endoscopic ultrasound in pancreatic cancer.

    PubMed

    Chang, David K; Nguyen, Nam Q; Merrett, Neil D; Dixson, Hugh; Leong, Rupert W L; Biankin, Andrew V

    2009-06-01

    Pancreatic cancer (PC) is the fourth most common cause of cancer deaths in Western societies. It is an aggressive tumor with an overall 5-year survival rate of less than 5%. Surgical resection offers the only possibility of cure and long-term survival for patients suffering from PC; however, unfortunately, fewer than 20% of patients suffering from PC have disease that is amendable to surgical resection. Therefore, it is important to accurately diagnose and stage these patients to enable optimal treatment of their disease. The imaging modalities involved in the diagnosis and staging of PC include multidetector CT scanning, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreaticography and MRI. The roles and relative importance of these imaging modalities have changed over the last few decades and continue to change owing to the rapid technological advances in medical imaging, but these investigations continue to be complementary. EUS was first introduced in the mid-1980s in Japan and Germany and has quickly gained acceptance. Its widespread use in the last decade has revolutionized the management of pancreatic disease as it simultaneously provides primary diagnostic and staging information, as well as enabling tissue biopsy. This article discusses the potential benefits and drawbacks of EUS in the primary diagnosis, staging and assessment of resectability, and EUS-guided fine-needle aspiration in PC. Difficult diagnostic scenarios and pitfalls are also discussed. A suggested management algorithm for patients with suspected PC is also presented. PMID:19485810

  7. Stereotypical Metabolic Response to Endoscopic Retrograde Cholangiopancreatography Show Alterations in Pancreatic Function Regardless of Post-Procedure Pancreatitis

    PubMed Central

    Lusczek, Elizabeth R; Colling, Kristen; Muratore, Sydne; Conwell, Darwin; Freeman, Martin; Beilman, Greg

    2016-01-01

    OBJECTIVES: Metabolomics-based diagnosis or prediction of risk may improve patient outcomes and improve understanding of the pathogenesis of acute pancreatitis (AP). Endoscopic retrograde cholangiopancreatography (ERCP) is a risk factor for developing AP. This pilot study examined metabolomes of patients before and after ERCP, hypothesizing that metabolomics could differentiate between patients who did and did not develop post-ERCP pancreatitis, and that biomarkers associated with development of AP could be identified. METHODS: Patients at high risk for developing post-ERCP pancreatitis were prospectively enrolled at the University of Minnesota from October 2012 to February 2014. Urine and serum samples were collected before ERCP, 2 h after ERCP, and daily thereafter if patients were admitted to the hospital with AP. Pancreatitis severity was calculated with Bedside Index for Severity in Acute Pancreatitis (BISAP) and Modified Glasgow scores. Patients who developed AP (n=9) were matched to patients who did not develop AP (n=18) by age and gender. Urine and serum metabolites were profiled with nuclear magnetic resonance spectroscopy. Partial least squares discriminant analysis (PLS-DA) was performed to detect changes in metabolic profiles associated with development of pancreatitis. Metabolic networks were constructed to probe functional relationships among metabolites. RESULTS: Of the 113 enrolled patients, 9 developed mild AP according to BISAP and modified Glasglow scores. PLS-DA showed common differences between pre- and post-ERCP metabolic profiles in urine and serum regardless of AP status, characterized by increases in serum and urine ketones and serum glucose. Pre-ERCP lipase levels were somewhat elevated in those who went on to develop AP, though this did not reach statistical significance. Metabolic networks differed between patients with AP and those without after ERCP; however, metabolomics did not identify specific prognostic or diagnostic markers of

  8. Antioxidant therapy in acute, chronic and post-endoscopic retrograde cholangiopancreatography pancreatitis: An updated systematic review and meta-analysis

    PubMed Central

    Gooshe, Maziar; Abdolghaffari, Amir Hossein; Nikfar, Shekoufeh; Mahdaviani, Parvin; Abdollahi, Mohammad

    2015-01-01

    AIM: To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis (AP), chronic pancreatitis (CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). METHODS: PubMed, Scopus, Google Scholar, Cochrane library database, and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP, CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization, blinding, and dropouts (withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant therapy. RESULTS: Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients were eligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference -2.59 d (95%CI: -4.25-(-0.93)], P = 0.002}. Although, antioxidant therapy had no significant effect on serum C reactive protein (CRP) after 5-7 d in AP patients [mean difference -9.57 (95%CI: -40.61-21.48, P = 0.55], it significantly reduced serum CRP after 10 d {mean difference -45.16 [95%CI: -89.99-(-0.33)], P = 0.048}. In addition, antioxidant therapy had no significant effect on CP-induced pain [mean difference -2.13 (95%CI: -5.87-1.6), P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05 (95%CI: 0.74-1.5), P = 0.78], severe PEP [mean difference 0.92 (95%CI: 0.43-1.97), P = 0.83], moderate PEP [mean difference 0.82 (95%CI: 0.54-1.23), P = 0.33], and mild PEP [mean difference 1.33 (95%CI: 0.99-1.78), P = 0.06]. Furthermore, while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference -20.61 (95%CI: -143.61-102.39), P = 0.74], it significantly reduced serum amylase close to 24-h

  9. ERCP (Endoscopic Retrograde Cholangiopancreatography)

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    ... Griffin Rodgers, Director of the NIDDK Clinical Trials Current research studies and how you can volunteer Community Outreach and Health Fairs Science-based information and tips for planning an outreach effort or community event For Health Care Professionals Patient and provider resources ...

  10. ERCP (Endoscopic Retrograde Cholangiopancreatography)

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    ... Tips for applicants; human subjects research information; grant review and management resources; and commonly used funding mechanisms, including diversity and small business programs Research Programs & Contacts Research program and staff ...

  11. Outcome of probe-based confocal laser endomicroscopy (pCLE) during endoscopic retrograde cholangiopancreatography: A single-center prospective study in 45 patients

    PubMed Central

    Lönnebro, Ragnar; Stigliano, Serena; Haas, Stephan L; Swahn, Fredrik; Enochsson, Lars; Noel, Rozh; Segersvärd, Ralf; Chiaro, Marco Del; Verbeke, Caroline S; Arnelo, Urban

    2015-01-01

    Background Diagnosis of pre-malignant and malignant lesions in the bile duct and the pancreas is sometimes cumbersome. This applies in particular to intraductal papillary mucinous neoplasia (IPMN) and bile duct strictures in primary sclerosing cholangitis (PSC). Aims To evaluate in a prospective cohort study the sensitivity and specificity of probe-based confocal laser microscopy (pCLE) during endoscopic retrograde cholangiopancreatography (ERCP). Methods We performed pCLE together with mother-baby endoscopy (SpyGlass) during 50 ERCP sessions in 45 patients. The Miami and Paris criteria were applied. Clinical diagnosis via imaging was compared to pCLE and the final pathological diagnosis from surgically-resected, biopsy, or cytology specimens. Patients were followed up for at least 1 year. Results We were able to perform pCLE in all patients. Prior to endoscopy, the diagnosis was benign in 23 patients and undetermined (suspicious) in 16 patients, while six patients had an unequivocal diagnosis of malignancy. Sensitivity was 91% and specificity 52%. The positive (PPV) and negative predictive value (NPV) was 82% and 100%, respectively. Apart from mild post-ERCP pancreatitis in two patients, no complications occurred. Conclusions Our study showed that pCLE is a safe, expert endoscopic method with high technical feasibility, high sensitivity and high NPV. It provided diagnostic information that can be helpful for decisions on patient management, especially in the case of IPMN and unclear pancreatic lesions, in individuals whom are at increased risk for pancreatic cancer. PMID:26668748

  12. Imaging of common bile duct by linear endoscopic ultrasound

    PubMed Central

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

    2015-01-01

    Imaging of common bile duct (CBD) can be done by many techniques. Endoscopic retrograde cholangiopancreaticography is considered the gold standard for imaging of CBD. A standard technique of imaging of CBD by endoscopic ultrasound (EUS) has not been specifically described. The available descriptions mention different stations of imaging from the stomach and duodenum. The CBD lies closest to duodenum and choice of imaging may be restricted to duodenum for many operators. Generally most operators prefer multi station imaging during EUS and the choice of selecting the initial station varies from operator to operator. Detailed evaluation of CBD is frequently the main focus of imaging during EUS and in such situations multi station imaging with a high-resolution ultrasound scanner may provide useful information. Examination of the CBD is one of the primary indications for doing an EUS and it can be done from five stations: (1) the fundus of stomach; (2) body of stomach; (3) duodenal bulb; (4) descending duodenum; and (5) antrum. Following down the upper 1/3rd of CBD can do imaging of entire CBD from the liver window and following up the lower 1/3rd of CBD can do imaging of entire CBD from the pancreatic window. This article aims at simplifying the techniques of imaging of CBD by linear EUS. PMID:26504506

  13. Endoscopic retrograde cholangio-pancreatographic diagnosis and extraction of massive biliary ascariasis presented with acute pancreatitis: a case report.

    PubMed

    Saowaros, V

    1999-05-01

    This paper reports the case of a young female Thai patient who presented with periodic severe abdominal pains which proved to be acute pancreatitis. Conventional investigations and treatments failed to prove and improve her condition. ERCP was done on the twelfth day after admission. 3 caudal ends of living round worms were noted protruding from the papillary orifice during endoscopy. Cholangiography revealed impacted multiple round worms in the common bile duct and both intrahepatic ducts. Endoscopic extraction of the worms was done by using dormia basket and removed with endoscope. Repeated procedure was done 21 times in two and a half hours, obtaining 26 live, mature Ascaris lumbricoides varying from 13 to 24 cm in length. Repeated cholangiogram confirmed complete removal of the worms. The patient was relieved from abdominal pain immediately after the procedure, and given oral albendazole 400 mg daily for 7 days. She was discharged asymptomatic 8 days after Ascaris removal. PMID:10443103

  14. Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection

    PubMed Central

    Gallagher, A; Malone, L; O’Reilly, G

    2013-01-01

    Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that combines the use of X-ray fluoroscopy and endoscopy for examination of the bile duct. Published data on ERCP doses are limited, including staff eye dose from ERCP. Occupational eye doses are of particular interest now as the International Commission on Radiological Protection (ICRP) has recommended a reduction in the dose limit to the lens of the eye. The aim of this study was to measure occupational eye doses obtained from ERCP procedures. Methods: A new eye lens dosemeter (EYE-D™, Radcard, Krakow, Poland) was used to measure the ERCP eye dose, Hp(3), at two endoscopy departments in Ireland. A review of radiation protection practice at the two facilities was also carried out. Results: The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented. Conclusion: Staff eye doses in ERCP have the potential to exceed the revised ICRP limit of 20 mSv per annum when an overcouch X-ray tube is used. The EYE-D dosemeter was found to be a convenient method for measuring lens dose. Eye doses in areas outside of radiology departments should be kept under review, particularly in light of the new ICRP eye dose limit. Advances in knowledge: Occupational eye lens doses from ERCP procedures have been established using a new commercially available dedicated Hp(3) dosemeter. PMID:23385992

  15. Comparing cost-effectiveness between endoscopic ultrasound and endoscopic retrograde cholangiopancreatography in diagnosis of common bile duct stone in patients with predefined risks: A study from a developing country

    PubMed Central

    Netinatsunton, Nisa; Attasaranya, Siriboon; Sottisuporn, Jaksin; Witeerungrot, Teepawit; Jongboonyanuparp, Theeratus; Piratvisuth, Teerha; Ovartlarnporn, Bancha

    2016-01-01

    Background and Objectives: Endoscopic ultrasound (EUS) achieves results comparable to endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of common bile duct (CBD) stone, but studies from the western have shown EUS to be less expensive in patients with intermediate risk for CBD stones. The aim of this study was to compare the costs of EUS and ERCP in the diagnosis of CBD stones in a developing country. Materials and Methods: A prospective study was done with 141 patients with suspected CBD stones, categorized as having high or intermediate risk for CBD stone. All underwent EUS, and the high-risk patients had ERCP after the EUS. For intermediate-risk patients, an ERCP was done at the discretion of the attending physician. The CBD stone was confirmed by ERCP in patients who underwent both EUS and ERCP. Patients who received EUS only were followed up every 3 months for 1 year. The false negative rate in patients with EUS and ERCP was estimated in the clinical follow-up. Result: One hundred and forty-one patients (141: 83 females, 58 males) with a mean age ± standard deviation (SD) of 55.71 ±18.68 years were recruited. Ninety-four (94) patients underwent both EUS and ERCP. ERCP confirmed the diagnosis in 83 of 85 patients (97.6%) with CBD stone detected by EUS. Forty-seven (47) patients with a negative EUS and no ERCP done were symptom-free during the follow-up. The overall sensitivity, specificity, positive predictive value, and negative predictive value of EUS were 97.6%, 80%, 97.6%, and 80% respectively. An EUS-based strategy for high-risk patients was 15% more expensive than an ERCP-based strategy, but the EUS-based strategy reduced the cost to 37.78% less than the ERCP-based strategy in intermediate-risk patients. The EUS-based strategy was cost-saving when the CBD stone prevalence was less than 52.5%. Conclusion: EUS is safer and less costly than ERCP for CBD stone diagnosis in patients with intermediate risk. PMID:27386473

  16. Understanding ERCP (Endoscopic Retrograde Cholangiopancreatography)

    MedlinePlus

    ... Patients PRESS ROOM Press Releases Media Backgrounders Patient Education Videos Glossary Media Spokespeople PUBLICATIONS GIE Journal Practice Guidelines Technology Reviews PIVIs ASGE Connection SCOPE ASGE Video Tips ...

  17. 0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangiopancreatography: A randomized study

    PubMed Central

    Kitamura, Katsuya; Yamamiya, Akira; Ishii, Yu; Sato, Yoshiki; Iwata, Tomoyuki; Nomoto, Tomohiro; Ikegami, Akitoshi; Yoshida, Hitoshi

    2015-01-01

    AIM: To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires (GWs) when used in wire-guided cannulation (WGC). METHODS: A single center, randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed, written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a naïve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria, and 269 patients were randomly allocated to two groups by a computer and analyzed: the 0.025-inch GW group (n = 109) and the 0.035-inch GW group (n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting, selective bile duct cannulation time, ERCP procedure time, the rate of pancreatic duct stent placement, the final success rate of selective bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP). RESULTS: The primary success rates of selective bile duct cannulation with WGC were 80.7% (88/109) and 86.3% (138/160) for the 0.025-inch and the 0.035-inch groups, respectively (P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique (46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups, respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting (66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups, respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7% (101/109) and 97.5% (156/160) for the 0.025-inch and 0.035-inch groups, respectively (P = 0

  18. Retrograde ejaculation

    MedlinePlus

    Retrograde ejaculation occurs when semen enters the bladder instead of going out through the urethra during ejaculation. ... bladder (bladder neck) does not close. This causes semen to go backwards into the bladder rather than ...

  19. Retrograde ejaculation

    MedlinePlus

    ... problem. Alternative Names Ejaculation retrograde; Dry climax Images Male reproductive system References Bhasin S, Basson R. Sexual dysfunction in men and women. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams ... management of male infertility. In: Wein AJ, ed. Campbell-Walsh Urology . ...

  20. Ureteral retrograde brush biopsy

    MedlinePlus

    Biopsy - brush - urinary tract; Retrograde ureteral brush biopsy cytology; Cytology - ureteral retrograde brush biopsy ... to be biopsied is rubbed with the brush. Biopsy forceps may be used instead to collect a ...

  1. Retrograde peri-implantitis.

    PubMed

    Mohamed, Jumshad B; Shivakumar, B; Sudarsan, Sabitha; Arun, K V; Kumar, T S S

    2010-01-01

    Retrograde peri-implantitis constitutes an important cause for implant failure. Retrograde peri-implantitis may sometimes prove difficult to identify and hence institution of early treatment may not be possible. This paper presents a report of four cases of (the implant placed developing to) retrograde peri-implantitis. Three of these implants were successfully restored to their fully functional state while one was lost due to extensive damage. The paper highlights the importance of recognizing the etiopathogenic mechanisms, preoperative assessment, and a strong postoperative maintenance protocol to avoid retrograde peri-implant inflammation. PMID:20922082

  2. Endoscopic management of benign biliary strictures

    PubMed Central

    Visrodia, Kavel H; Tabibian, James H; Baron, Todd H

    2015-01-01

    Endoscopic management of biliary obstruction has evolved tremendously since the introduction of flexible fiberoptic endoscopes over 50 years ago. For the last several decades, endoscopic retrograde cholangiopancreatography (ERCP) has become established as the mainstay for definitively diagnosing and relieving biliary obstruction. In addition, and more recently, endoscopic ultrasonography (EUS) has gained increasing favor as an auxiliary diagnostic and therapeutic modality in facilitating decompression of the biliary tree. Here, we provide a review of the current and continually evolving role of gastrointestinal endoscopy, including both ERCP and EUS, in the management of biliary obstruction with a focus on benign biliary strictures. PMID:26322153

  3. Imaging of the pancreatic duct by linear endoscopic ultrasound

    PubMed Central

    Sharma, Malay; Rai, Praveer; Rameshbabu, Chittapuram Srinivasan; Arya, Shalini

    2015-01-01

    The current gold standard investigation for anatomic exploration of the pancreatic duct (PD) is endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography is a noninvasive method for exploration of the PD. A comprehensive evaluation of the course of PD and its branches has not been described by endoscopic ultrasound (EUS). In this article, we describe the techniques of imaging of PD using linear EUS. PMID:26374577

  4. Endoscopic Intermetatarsal Ligament Decompression.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal. PMID:27284515

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

    PubMed Central

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

    2012-01-01

    Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL. PMID:22924043

  6. Emerging Trends in Retrograde Signaling.

    PubMed

    Suvarna, Yashasvi; Maity, Nivedita; Shivamurthy, M C

    2016-05-01

    Retrograde signaling is defined as the signaling events leading from the plastids to the nucleus in plants and across the chemical synapse, from the postsynaptic neuron to the presynaptic neuron in animals. The discovery of various retrograde messengers has opened many avenues and clouds of thoughts as to the role of retrograde signaling. They have been implicated particularly in long-term potentiation (LTP) and synaptic plasticity. But the basic assumptions about retrograde signaling have not been studied upon for many years. This review focuses on established facts and hypothesis put forward in retrograde signaling. PMID:26081150

  7. Endoscopic ultrasound

    MedlinePlus

    Endoscopic ultrasound is a type of imaging test. It is used to see organs in and near the digestive ... Ultrasound is a way to see the inside of the body using high-frequency sound waves. Endoscopic ...

  8. Endoscopic management of chronic pancreatitis

    PubMed Central

    Oza, Veeral M; Kahaleh, Michel

    2013-01-01

    Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications. PMID:23330050

  9. Endoscopic diagnostic of chronic pancreatitis.

    PubMed

    Cubranić, Aleksandar; Dintinjana, Renata Dobrila; Vanis, Nenad

    2014-12-01

    Chronic pancreatitis is defined as a continuous inflammatory pancreatic disease, one characterized by irreversible morphological changes, often associates with pain and sometimes with the loss of endocrine and exocrine function. As a histological confirmation of chronic pancreatitis is often unavailable, the diagnosis is traditionally based on imaging methods such as computerized tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP), and recently magnetic resonance cholangiopancreatography (MRCP) as a noninvasive alternative to ERCP. Developments in the classification system of CP include the Marseille classification of 1963 which offered histopathologic criteria for CP, the Cambridge classification of 1984 which introduced imaging features of computed tomography (CT), transabdominal ultrasound (TUS) and endoscopic retrograde cholangiopancreatography (ERCP) for classification of CP as well as Rosemont classification system of 2007 which presented the endoscopic ultrasonography diagnosis of CP. Endoscopic ultra-sonography (EUS) was first introduced as a diagnostic method for evaluation of pancreatic disease in 1986. It has experienced significant improvements since then and allowed for an alternative approach in diagnosing patients with pancreatic diseases. In patients with suspected pancreatic masses EUS-guided fine needle aspiration (EUS-FNA) is the best method for obtaining tissue diagnosis and differentiating CP from pancreatic carcinoma. The recent studies indicate that EUS is the method of choice when compared with other imaging methods such as ERCP because it frequently provides more accurate diagnostics. The aim of this review is to discuss the findings in endoscopic diagnostics up to the present moment and to indicate advantages, limitations and possible complications along with the current recommendations in CP diagnostics. PMID:25842773

  10. Advanced endoscopic imaging of indeterminate biliary strictures

    PubMed Central

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

    2015-01-01

    Endoscopic evaluation of indeterminate biliary strictures (IDBSs) has evolved considerably since the development of flexible fiberoptic endoscopes over 50 years ago. Endoscopic retrograde cholangiography pancreatography (ERCP) was introduced nearly a decade later and has since become the mainstay of therapy for relieving obstruction of the biliary tract. However, longstanding methods of ERCP-guided tissue acquisition (i.e., biliary brushings for cytology and intraductal forceps biopsy for histology) have demonstrated disappointing performance characteristics in distinguishing malignant from benign etiologies of IDBSs. The limitations of these methods have thus helped drive the search for novel techniques to enhance the evaluation of IDBSs and thereby improve diagnosis and clinical care. These modalities include, but are not limited to, endoscopic ultrasound, intraductal ultrasound, cholangioscopy, confocal endomicroscopy, and optical coherence tomography. In this review, we discuss established and emerging options in the evaluation of IDBSs. PMID:26675379

  11. Endoscopic Ultrasound-Assisted Pancreaticobiliary Access.

    PubMed

    Weilert, Frank; Binmoeller, Kenneth F

    2015-10-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is the primary approach to drain an obstructed pancreatic or biliary duct. Failed biliary drainage is traditionally referred for percutaneous transhepatic biliary drainage or surgical bypass, which carry significantly higher morbidity and mortality rates compared with ERCP and transpapillary drainage. Endoscopic ultrasound provides a real-time imaging platform to access and deliver therapy to organs and tissues outside of the bowel lumen. The bile and pancreatic ducts can be directly accessed from the stomach and duodenum, offering an alternative to ERCP when this fails or is not feasible. PMID:26431606

  12. Endoscopic ultrasound-guided hepaticogastrostomy using a 6-F cystotome and 12-cm covered metal stent

    PubMed Central

    Mandai, Koichiro; Uno, Koji; Okada, Yusuke; Suzuki, Azumi; Yasuda, Kenjiro

    2016-01-01

    Background and study aims: An iincreasing number of reports describe endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction in patients with endoscopic retrograde cholangiopancreatography failure. However, this procedure has not yet been standardized; as a result, the rate of adverse events, including bile leakage and stent migration, is relatively high. Here, we report our experience with four cases of endoscopic ultrasound-guided hepaticogastrostomy performed according to our institutional procedure. PMID:27004245

  13. Developments in flexible endoscopic surgery: a review

    PubMed Central

    Feussner, Hubertus; Becker, Valentin; Bauer, Margit; Kranzfelder, Michael; Schirren, Rebekka; Lüth, Tim; Meining, Alexander; Wilhelm, Dirk

    2015-01-01

    Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel – for long a “white spot” for gastrointestinal endoscopy – and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions. Though still technically challenging, it is increasingly facilitated by new manipulation techniques and tools that are being steadily optimized. Closure of wall defects and hemostasis could be improved significantly. Even the anatomy beyond the gastrointestinal wall is being explored by the therapeutic use of endoluminal ultrasound. Endosonographic-guided surgery is not only a suitable fallback solution if conventional endoscopic retrograde cholangiopancreatography fails, but even makes necrosectomy procedures, abscess drainage, and neurolysis feasible for the endoscopist. Newly developed endoscopic approaches aim at formerly distinctive surgical domains like gastroesophageal reflux disease, appendicitis, and cholecystitis. Combined endoscopic/laparoscopic interventional techniques could become the harbingers of natural orifice transluminal endoscopic surgery, whereas pure natural orifice transluminal endoscopic surgery is currently still in its beginnings. PMID:25565878

  14. Endoscopic Gallbladder Drainage for Acute Cholecystitis

    PubMed Central

    Widmer, Jessica; Alvarez, Paloma; Sharaiha, Reem Z.; Gossain, Sonia; Kedia, Prashant; Sarkaria, Savreet; Sethi, Amrita; Turner, Brian G.; Millman, Jennifer; Lieberman, Michael; Nandakumar, Govind; Umrania, Hiren; Gaidhane, Monica

    2015-01-01

    Background/Aims Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities. PMID:26473125

  15. Reality named endoscopic ultrasound biliary drainage.

    PubMed

    Guedes, Hugo Gonçalo; Lopes, Roberto Iglesias; de Oliveira, Joel Fernandez; Artifon, Everson Luiz de Almeida

    2015-10-25

    Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology. PMID:26504507

  16. Reality named endoscopic ultrasound biliary drainage

    PubMed Central

    Guedes, Hugo Gonçalo; Lopes, Roberto Iglesias; de Oliveira, Joel Fernandez; Artifon, Everson Luiz de Almeida

    2015-01-01

    Endoscopic ultrasound (EUS) is used for diagnosis and evaluation of many diseases of the gastrointestinal (GI) tract. In the past, it was used to guide a cholangiography, but nowadays it emerges as a powerful therapeutic tool in biliary drainage. The aims of this review are: outline the rationale for endoscopic ultrasound-guided biliary drainage (EGBD); detail the procedural technique; evaluate the clinical outcomes and limitations of the method; and provide recommendations for the practicing clinician. In cases of failed endoscopic retrograde cholangiopancreatography (ERCP), patients are usually referred for either percutaneous transhepatic biliary drainage (PTBD) or surgical bypass. Both these procedures have high rates of undesirable complications. EGBD is an attractive alternative to PTBD or surgery when ERCP fails. EGBD can be performed at two locations: transhepatic or extrahepatic, and the stent can be inserted in an antegrade or retrograde fashion. The drainage route can be transluminal, duodenal or transpapillary, which, again, can be antegrade or retrograde [rendezvous (EUS-RV)]. Complications of all techniques combined include pneumoperitoneum, bleeding, bile leak/peritonitis and cholangitis. We recommend EGBD when bile duct access is not possible because of failed cannulation, altered upper GI tract anatomy, gastric outlet obstruction, a distorted ampulla or a periampullary diverticulum, as a minimally invasive alternative to surgery or radiology. PMID:26504507

  17. Endoscopic management of benign biliary strictures.

    PubMed

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Benign biliary strictures are a common indication for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic management has evolved over the last 2 decades as the current standard of care. The most common etiologies of strictures encountered are following surgery and those related to chronic pancreatitis. High-quality cross-sectional imaging provides a road map for endoscopic management. Currently, sequential placement of multiple plastic biliary stents represents the preferred approach. There is an increasing role for the treatment of these strictures using covered metal stents, but due to conflicting reports of efficacies as well as cost and complications, this approach should only be entertained following careful consideration. Optimal management of strictures is best achieved using a team approach with the surgeon and interventional radiologist playing an important role. PMID:25613176

  18. Predictors of re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy bleeding

    PubMed Central

    Lee, Mu-Hsien; Tsou, Yung-Kuan; Lin, Cheng-Hui; Lee, Ching-Song; Liu, Nai-Jen; Sung, Kai-Feng; Cheng, Hao-Tsai

    2016-01-01

    AIM: To predict the re-bleeding after endoscopic hemostasis for delayed post-endoscopic sphincterotomy (ES) bleeding. METHODS: Over a 15-year period, data from 161 patients with delayed post-ES bleeding were retrospectively collected from a single medical center. To identify risk factors for re-bleeding after initial successful endoscopic hemostasis, parameters before, during and after the procedure of endoscopic retrograde cholangiopancreatography were analyzed. These included age, gender, blood biochemistry, co-morbidities, endoscopic diagnosis, presence of peri-ampullary diverticulum, occurrence of immediate post-ES bleeding, use of needle knife precut sphincterotomy, severity of delayed bleeding, endoscopic features on delayed bleeding, and type of endoscopic therapy. RESULTS: A total of 35 patients (21.7%) had re-bleeding after initial successful endoscopic hemostasis for delayed post-ES bleeding. Univariate analysis revealed that malignant biliary stricture, serum bilirubin level of greater than 10 mg/dL, initial bleeding severity, and bleeding diathesis were significant predictors of re-bleeding. By multivariate analysis, serum bilirubin level of greater than 10 mg/dL and initial bleeding severity remained significant predictors. Re-bleeding was controlled by endoscopic therapy in a single (n = 23) or multiple (range, 2-7; n = 6) sessions in 29 of the 35 patients (82.9%). Four patients required transarterial embolization and one went for surgery. These five patients had severe bleeding when delayed post-ES bleeding occurred. One patient with decompensated liver cirrhosis died from re-bleeding. CONCLUSION: Re-bleeding occurs in approximately one-fifth of patients after initial successful endoscopic hemostasis for delayed post-ES bleeding. Severity of initial bleeding and serum bilirubin level of greater than 10 mg/dL are predictors of re-bleeding. PMID:27003996

  19. Dual Balloon-Occluded Retrograde Transvenous Obliteration of Gastric Varix Draining into the Left Adrenal Vein and Left Inferior Phrenic Vein

    SciTech Connect

    Nishida, Norifumi Ninoi, Teruhisa; Kitayama, Toshiaki; Yamamoto, Akira; Sakai, Yukimasa; Sato, Kimihiko; Hamuro, Masao; Nakamura, Kenji; Inoue, Yuichi; Yamada, Ryusaku

    2004-09-15

    A 66-year-old woman with a gastric varix, draining into a dilated left adrenal vein and a left inferior phrenic vein, was treated with dual balloon-occluded retrograde transvenous obliteration (B-RTO). Under balloon occlusion of the left adrenal vein and the left inferior phrenic vein, retrograde injection of a sclerosant (5% ethanolamine oleate) into the gastric varix was performed. Two weeks later, disappearance of flow in the gastric varix was confirmed on endoscopic ultrasound examination.

  20. Endoscopic Sinus Surgery

    MedlinePlus

    ... The nasal endoscope is a small, lighted metal telescope placed into the nostril. The endoscope allows the ... sinus surgery involves the use of a small telescope (nasal endoscope) that is inserted through the nostril ...

  1. Endoscopic neurosurgery.

    PubMed

    Auer, L M; Holzer, P; Ascher, P W; Heppner, F

    1988-01-01

    This paper describes an ultrasound-guided, laser-assisted, and TV-controlled endoscopic technique which has been used so far in 133 patients for a variety of intracranial lesions. Following CT or MRI image reconstruction, and a decision on the placement of a 1 cm or a 2 cm burrhole, a 1 cm 5.0 mHz or 7.5 mHz intraoperative ultrasound probe is used to direct the endoscope from the burrhole to the target area. A 22.5 cm long rigid endoscope tube with an outer diameter of 6 mm with an inbuilt suction irrigation system, Neodymium Yag laser with 600 micron Quartz glass-fibre and an inlet for various microinstruments is then introduced. The attachment of a TV camera to the ocular lens allows the operator to control further surgical steps in the target area via the TV screen and thus warrants sterility in the operating field. The technique has been used for evacuation of 77 spontaneous intracerebral haematomas (lobar, putaminal, thalamic), 8 traumatic intracerebral haematomas, 13 ventricular haematomas, 8 cerebellar haematomas and 1 brainstem haematoma. Total or subtotal evacuation was achieved in 33% of intracerebral haematomas, removal of more than 50% of the clot in 55%. Twenty-four brain tumours (12 ventricular, 12 cystic cerebral or cerebellar tumours) were operated on for biopsy, evacuation of cyst, resection or removal of the cyst wall and/or laser irradiation of solid tumour or the inner cyst wall of cystic tumours. The complication rate probably related to surgery was 1.6%, morbidity 1.6%, mortality 0%. This high-tec endoscopic technique with its minimal surgical trauma and short operation time can be recommended as a low-risk alternative to conventional neurosurgical techniques. PMID:3278501

  2. Endoscopic cyclophotocoagulation.

    PubMed

    Seibold, Leonard K; SooHoo, Jeffrey R; Kahook, Malik Y

    2015-01-01

    In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure. PMID:25624669

  3. Endoscopic Cyclophotocoagulation

    PubMed Central

    Seibold, Leonard K.; SooHoo, Jeffrey R.; Kahook, Malik Y.

    2015-01-01

    In recent years, many new procedures and implants have been introduced as safer alternatives for the surgical treatment of glaucoma. The majority of these advances are implant-based with a goal of increased aqueous drainage to achieve lower intraocular pressure (IOP). In contrast, endoscopic cyclophotocoagulation (ECP) lowers IOP through aqueous suppression. Although ciliary body ablation is a well-established method of aqueous suppression, the novel endoscopic approach presents a significant evolution of this treatment with marked improvement in safety. The endoscope couples a light source, video imaging, and diode laser to achieve direct visualization of the ciliary processes during controlled laser application. The result is an efficient and safe procedure that can achieve a meaningful reduction in IOP and eliminate or reduce glaucoma medication use. From its initial use in refractory glaucoma, the indications for ECP have expanded broadly to include many forms of glaucoma across the spectrum of disease severity. The minimally-invasive nature of ECP allows for easy pairing with phacoemulsification in patients with coexisting cataract. In addition, the procedure avoids implant or device-related complications associated with newer surgical treatments. In this review, we illustrate the differences between ECP and traditional cyclophotocoagulation, then describe the instrumentation, patient selection, and technique for ECP. Finally, we summarize the available clinical evidence regarding the efficacy and safety of this procedure. PMID:25624669

  4. Retrograde signaling: Organelles go networking.

    PubMed

    Kleine, Tatjana; Leister, Dario

    2016-08-01

    The term retrograde signaling refers to the fact that chloroplasts and mitochondria utilize specific signaling molecules to convey information on their developmental and physiological states to the nucleus and modulate the expression of nuclear genes accordingly. Signals emanating from plastids have been associated with two main networks: 'Biogenic control' is active during early stages of chloroplast development, while 'operational' control functions in response to environmental fluctuations. Early work focused on the former and its major players, the GUN proteins. However, our view of retrograde signaling has since been extended and revised. Elements of several 'operational' signaling circuits have come to light, including metabolites, signaling cascades in the cytosol and transcription factors. Here, we review recent advances in the identification and characterization of retrograde signaling components. We place particular emphasis on the strategies employed to define signaling components, spanning the entire spectrum of genetic screens, metabolite profiling and bioinformatics. This article is part of a Special Issue entitled 'EBEC 2016: 19th European Bioenergetics Conference, Riva del Garda, Italy, July 2-6, 2016', edited by Prof. Paolo Bernardi. PMID:26997501

  5. Endoscopic Management of Bile Leakage after Liver Transplantation

    PubMed Central

    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

  6. Portal biliopathy treated with endoscopic biliary stenting

    PubMed Central

    Jeon, Sung Jin; Min, Jae Ki; Kwon, So Young; Kim, Jun Hyun; Moon, Sun Young; Lee, Kang Hoon; Kim, Jeong Han; Choe, Won Hyeok; Cheon, Young Koog; Kim, Tae Hyung; Park, Hee Sun

    2016-01-01

    Portal biliopathy is defined as abnormalities in the extra- and intrahepatic ducts and gallbladder of patients with portal hypertension. This condition is associated with extrahepatic venous obstruction and dilatation of the venous plexus of the common bile duct, resulting in mural irregularities and compression of the biliary tree. Most patients with portal biliopathy remain asymptomatic, but approximately 10% of them advance to symptomatic abdominal pain, jaundice, and fever. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are currently used as diagnostic tools because they are noninvasive and can be used to assess the regularity, length, and degree of bile duct narrowing. Management of portal biliopathy is aimed at biliary decompression and reducing the portal pressure. Portal biliopathy has rarely been reported in Korea. We present a symptomatic case of portal biliopathy that was complicated by cholangitis and successfully treated with biliary endoscopic procedures. PMID:27044769

  7. Endoscopic Ultrasonograpy for Choledocholithiasis and Biliary Malignancy.

    PubMed

    Moparty, Bhavani; Bhutani, Manoop S

    2005-04-01

    Endoscopic ultrasound (EUS) is a valuable tool in gastrointestinal endoscopy, with various applications such as diagnosis, staging, and evaluation of the pancreaticobiliary system. EUS has comparable sensitivity to magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for detection of choledocholithiasis. EUS may be considered for evaluation for choledocholithiasis as prelude to ERCP when there is a low to intermediate suspicion for common bile duct stones or when there is an increased risk for complications from ERCP. Endosonography may also be useful in the evaluation of cholangiocarcinoma. Intraductal ultrasound within the bile duct may help differentiate malignant from benign strictures. EUS-guided fine needle aspiration can be helpful in the diagnosis of cholangiocarcinoma, especially in the region of the hilum. PMID:15769435

  8. Endoscopic Microscopy

    PubMed Central

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

    2002-01-01

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

  9. International Live Endoscopic Multichannel Demonstration Using Superfast Broadband Internet Connections

    PubMed Central

    Lee, Sang Pyo; Lee, Hang Lak; Choi, Ho Soon; Joe, Inwhee; Shimizu, Shuji

    2012-01-01

    Background/Aims Telemedicine is a convenient and efficient tool for remote education in various fields. The telemedicine system can also be used to educate doctors and medical students. The aim of our study was to establish the effectiveness of the telemedical system for use in a live endoscopic multichannel demonstration conference and to test the effectiveness and usefulness of a multicenter-based live endoscopic demonstration through live, interactive, high resolution video transmission using advanced networks and the digital video transport system (DVTS). Methods This study is a prospective multicenter pilot study. A live demonstration of an endoscopic submucosal dissection (ESD) and an endoscopic retrograde cholangiopancreatography (ERCP) using advanced network technology was performed. Results The DVTS successfully transmitted uncompressed, high-resolution, digital lectures with endoscopy video during a multichannel endoscopic live demonstration of ESD and ERCP over multiple advanced networks. The overall satisfaction rating when the endoscopic lecture demonstration was performed by combining DVTS was generally good. Conclusions We believe that a multicenter-based live endoscopic demonstration is a very effective conferencing method when using advanced networks and DVTS. PMID:22741135

  10. [Pain and jaundice secondary to hemobilia resolved by ERCP and endoscopic sphincterectomy].

    PubMed

    Defarges, V; Loscos, J M; Meroño, E; Fernández Madrid, J; Carda, P

    1996-06-01

    We report the case of a patient with hemobilia resulting from a liver biopsy where the performance of the endoscopic sphincterectomy solved the jaundice and the pain of the patient. ERCP has been used previously in the diagnosis of biliary and pancreatic tumors that manifested themselves as an hemobilia. The therapeutic utilization of endoscopic sphincterotomy had been described rarely in this type of bleedings. We recommend endoscopic retrograde cholangiopancreatography and sphincterotomy in the cases of hemobilia with severe abdominal pain resulting from the accumulation of clots inside the biliary tract. PMID:8755328

  11. Retrograde dilation of a complex radiation-induced esophageal stricture through percutaneous gastrostomy.

    PubMed

    Eminler, A T; Uslan, M I; Köksal, A Ş; Guven, M; Parlak, E

    2015-06-01

    Upper esophageal strictures occur in approximately 3-4% of patients who receive radiotherapy for head and neck cancers. The standart initial treatment is dilation by using bougie or through-the-scope balloon dilators. Endoscopic treatment requires the passage of a guidewire through the stricture which cannot be accomplished in some of the patients with complex strictures. Retrograde dilation of esophageal strictures through a mature percutaneous gastrostomy tract have been reported in a limited number of cases and small case series up to date and can be considered as a rescue treatment before considering surgery in such patients. Herein we report retrograde dilatation of a radiation-induced complex esophageal stricture through the percutaneous gastrostomy tract in a patient with operated larynx cancer. PMID:26151697

  12. Endoscopic management of post-liver transplant biliary complications.

    PubMed

    Girotra, Mohit; Soota, Kaartik; Klair, Jagpal S; Dang, Shyam M; Aduli, Farshad

    2015-05-16

    Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. PMID:25992185

  13. State-of-the-art endoscopic procedures for pancreatic cancer.

    PubMed

    Coronel, Emmanuel; Waxman, Irving

    2016-09-01

    Pancreatic cancer is the twelfth most common cancer worldwide, taking the fourth place in cancer-related mortality in western countries. Despite significant efforts in understanding the tumor biology of pancreatic cancer and introducing new technologies and therapies to improve the detection, staging and treatment of this disease, pancreatic cancer continues to have a high and almost unchanged mortality. In the last few decades, the development of techniques such as endoscopic retrograde cholangio pancreatography and endoscopic ultrasound have allowed us to directly access the pancreaticobiliary system and fight pancreatic cancer and its complications from different fronts. Our goal with this review is to discuss the most cutting-edge endoscopic techniques available in our armamentarium to diagnose, stage and treat pancreatic cancer. PMID:27339021

  14. Endoscopic management of post-liver transplant biliary complications

    PubMed Central

    Girotra, Mohit; Soota, Kaartik; Klair, Jagpal S; Dang, Shyam M; Aduli, Farshad

    2015-01-01

    Biliary complications are being increasingly encountered in post liver transplant patients because of increased volume of transplants and longer survival of these recipients. Overall management of these complications may be challenging, but with advances in endoscopic techniques, majority of such patients are being dealt with by endoscopists rather than the surgeons. Our review article discusses the recent advances in endoscopic tools and techniques that have proved endoscopic retrograde cholangiography with various interventions, like sphincterotomy, bile duct dilatation, and stent placement, to be the mainstay for management of most of these complications. We also discuss the management dilemmas in patients with surgically altered anatomy, where accessing the bile duct is challenging, and the recent strides towards making this prospect a reality. PMID:25992185

  15. Endoscopic management of choledocholithiasis and cholelithiasis in patients with cirrhosis.

    PubMed

    Khan, Ali S; Eloubeidi, Mohamad A; Khashab, Mouen A

    2016-07-01

    Treatment of choledocholithiasis and cholelithiasis in patients with cirrhosis often requires diagnostic and therapeutic endoscopy such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Patients with underlying cirrhosis may have coagulopathy, hepatic encephalopathy, ascites and other comorbidities associated with cirrhosis that can make endoscopic therapy challenging and can be associated with a higher risk of adverse events. Given the unique derangements of physiologic parameters associated with cirrhosis this population requires a truly multifaceted and multidisciplinary understanding between therapeutic endoscopists, hepatologists and anesthesiologists. For therapeutic endoscopists, it is critical to be aware of the specific issues unique to this population of patients to optimize outcomes and avoid adverse events. The epidemiology of gallstone disease, the diagnostic and therapeutic approach to patients with varying degree of hepatic dysfunction, and a review of the available literature in this area are presented. PMID:26799755

  16. Retrograde Percutaneous Transjejunal Creation of Biliary Neoanastomoses in Patients with Complete Hepaticojejunostomy Dehiscence.

    PubMed

    Mansueto, Giancarlo; Contro, Alberto; Zamboni, Giulia A; De Robertis, Riccardo

    2015-10-01

    A technique of percutaneous hepaticojejunostomy (PHJ) was developed to allow creation of a neoanastomosis in cases of hepaticojejunostomy (HJ) dehiscence when endoscopic intervention is unfeasible as a result of postsurgical anatomy. PHJ involves transhepatic biliary catheterization and transjejunal retrograde enterotomy. A rendezvous establishes the communication between the bile ducts and the jejunum. PHJ was performed in five patients, and neoanastomosis creation without residual biliary leak was achieved in all cases, with no procedure-related complications. Bilirubin levels and white blood cell counts quickly decreased after PHJ (median, 1 d; range, 1-4 d). Median survival after PHJ was 210 days (range, 45-540 d). PMID:26408218

  17. Ultrathin flexible endoscopes for ureteroscopy. A preliminary experimental and clinical study.

    PubMed

    Vorreuther, R; Franzen, W; Engelking, R

    1989-01-01

    Recent advances in fiberoptic technology have resulted in the development of endoscopes with an outer diameter of less than 6 F, including an irrigating or working channel. After preliminary testing of these ultrathin fiberscopes for ureteroscopy on 6 pigs, 17 patients were examined during routine retrograde pyelography. Prototypes of flexible endoscopes without an actively deflectable tip and an outer diameter of 5.5 F (= 1.8 mm) and a 1.5 F (= 0.5 mm) channel were used. Fine-needle aspiration cytology was obtained through the channel. The feasibility, performance and benefits of ureteroscopy with ultrathin, flexible endoscopes were evaluated. At present the lack of maneuverability and the fragility of the fiberscopes limit this method. Yet its routine clinical use, in addition to retrograde ureteropyelography under local anesthesia, shows great promise. PMID:2623553

  18. Retrograde flexible ureteroscopy-assisted retroperitoneal laparoscopic ureteroureterostomy for refractory ureteral stricture: A case report

    PubMed Central

    Tsuru, Nobuo; Mugiya, Soichi; Sato, Shigenori

    2016-01-01

    Introduction Laparoscopic ureteroureterostomy (UU) is a preferred and valid minimally invasive procedure for treatment of benign ureteral strictures. In some cases with chronic inflammation or after repeated endoscopic ureteral surgery, it is difficult to identify the location of a ureteral stricture. Presentation of case We report a case of 48-year-old man with an impacted stone after laparoscopic partial nephrectomy. Although transurethral lithotripsy (TUL) was performed, the ureteral stricture did not improve by subsequent endoscopic ureteral Holmium laser incision and balloon dilation. Discussion To simultaneously identify the exact location of the constriction, we performed retroperitoneal laparoscopic ureteroureterostomy with intraoperative observations via super-slim flexible fiberoptic ureteroscopy retrograde. Conclusions Accurate identification of the ureteral stricture via observation by laparoscopy and observation by ureteroscopy was feasible. In contrast to the use of a rigid ureteroscopy, flexible fiberoptic ureteroscopy did not require placing the patient in an unnatural position. PMID:26826930

  19. Placement of multiple metal stents for malignant intrahepatic biliary obstruction via an endoscopic ultrasound-guided choledochoduodenostomy fistula.

    PubMed

    Akiyama, Dai; Hamada, Tsuyoshi; Nakai, Yousuke; Isayama, Hiroyuki; Takagi, Kaoru; Mizuno, Suguru; Koike, Kazuhiko

    2015-01-01

    Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using a fully-covered self-expandable metal stent (SEMS) is increasingly used as an alternative to failed endoscopic retrograde cholangiopancreatography. An EUS-CDS fistula can provide endoscopists with a new approach route for intrahepatic bile ducts. Here, we present successful placement of multiple SEMS for intrahepatic biliary obstruction via an EUS-CDS fistula. PMID:26462843

  20. Endoscopic assessment of primary sclerosing cholangitis.

    PubMed

    De Vries, Boudewijn; Weersma, Rinse K

    2016-03-01

    Primary sclerosing cholangitis (PSC) is a rare chronic liver disease of unknown etiology for which the only known curative treatment is liver transplantation. The disease is defined by progressive inflammation and fibrosis of the bile ducts, causing biliary strictures and cholestasis. Common complications of the disease are the presence of biliary lithiasis requiring stone extraction, and development of dominant bile duct strictures requiring balloon dilatation and stent placement through endoscopic retrograde cholangiopancreatography. The increased development of cholangiocarcinoma is a dreaded complication in PSC, as it is often detected in an advanced stage and is associated with a poor prognosis. Several endoscopic techniques, including endoscopic ultrasound, confocal laser endomicroscopy and peroral cholangioscopy are applied in the management of PSC and detection of cholangiocarcinoma. Tissue sampling through different types of biopsies and biliary brush combined with fluorescence in situ hybridization are used to differentiate benign dominant strictures from biliary neoplasia. Nonetheless early detection of cholangiocarcinoma in PSC remains a clinical challenge requiring a specialized diagnostic workup. The aim of this review is to discuss the role of diagnostic and therapeutic endoscopy in management of PSC, providing an overview of current literature. PMID:26446685

  1. Gallstone Ileus following Endoscopic Stone Extraction

    PubMed Central

    Wakui, Noritaka; Asai, Yasutsugu; Dan, Nobuhiro; Takeda, Yuki; Ueki, Nobuo; Otsuka, Takahumi; Oba, Nobuyuki; Nisinakagawa, Shuta; Kojima, Tatsuya

    2014-01-01

    An 85-year-old woman was an outpatient treated at Tokyo Rosai Hospital for cirrhosis caused by hepatitis B. She had previously been diagnosed as having common bile duct stones, for which she underwent endoscopic retrograde cholangiopancreatography (ERCP). However, as stone removal was unsuccessful, a plastic stent was placed after endoscopic sphincterotomy. In October 2012, the stent was replaced endoscopically because she developed cholangitis due to stent occlusion. Seven days later, we performed ERCP to treat recurring cholangitis. During the procedure, the stone was successfully removed by a balloon catheter when cleaning the common bile duct. The next day, the patient developed abdominal pain, abdominal distension, and nausea and was diagnosed as having gallstone ileus based on abdominal computed tomography (CT) and abdominal ultrasonography findings of an incarcerated stone in the terminal ileum. Although colonoscopy was performed after inserting an ileus tube, no stone was visible. Subsequent CT imaging verified the disappearance of the incarcerated stone from the ileum, suggesting that the stone had been evacuated naturally via the transanal route. Although it is extremely rare for gallstone ileus to develop as a complication of ERCP, physicians should be aware of gallstone ileus and follow patients carefully, especially after removing huge stones. PMID:25328725

  2. Endoscopic therapy in chronic pancreatitis: current perspectives.

    PubMed

    Seicean, Andrada; Vultur, Simona

    2015-01-01

    Endoscopic therapy in chronic pancreatitis (CP) aims to provide pain relief and to treat local complications, by using the decompression of the pancreatic duct and the drainage of pseudocysts and biliary strictures, respectively. This is the reason for using it as first-line therapy for painful uncomplicated CP. The clinical response has to be evaluated at 6-8 weeks, when surgery may be chosen. This article reviews the main possibilities of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) therapies. Endotherapy for pancreatic ductal stones uses ultrasound wave lithotripsy and sometimes additional stone extractions. The treatment of pancreatic duct strictures consists of a single large stenting for 1 year. If the stricture persists, simultaneous multiple stents are applied. In case of unsuccessful ERCP, the EUS-guided drainage of the main pancreatic duct (MPD) or a rendezvous technique can solve the ductal strictures. EUS-guided celiac plexus block has limited efficiency in CP. The drainage of symptomatic or complicated pancreatic pseudocysts can be performed transpapillarily or transgastrically/transduodenally, preferably by EUS guidance. When the biliary stricture is symptomatic or progressive, multiple plastic stents are indicated. In conclusion, as in many fields of symptomatic treatment, endoscopy remains the first choice, either by using ERCP or EUS-guided procedures, after consideration of a multidisciplinary team with endoscopists, surgeons, and radiologists. However, what is crucial is establishing the right timing for surgery. PMID:25565876

  3. Endoscopic ultrasound guided interventional procedures

    PubMed Central

    Sharma, Vishal; Rana, Surinder S; Bhasin, Deepak K

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS. PMID:26078831

  4. Outcome and Safety of Anterograde and Retrograde Single-Balloon Enteroscopy: Clinical Experience at a Tertiary Medical Center in Taiwan

    PubMed Central

    Lin, Meng-Chiung; Chen, Peng-Jen; Shih, Yu-Lueng; Huang, Hsin-Hung; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Huang, Tien-Yu

    2016-01-01

    Single-balloon enteroscopy (SBE) is designed for identifying possible small bowel lesions with balloon-assisted enteroscopy that allows deep intubation of the intestine. However, data regarding the outcome and safety of SBE remain limited. We conducted this study to evaluate the outcome and safety of anterograde and retrograde SBE approaches. This retrospective review from a tertiary medical center in Taiwan included endoscopic reports and chart data from 128 patients with 200 anterograde and retrograde procedures from September 2009 to November 2014. In this study, the most common indication for both anterograde and retrograde SBE was obscure gastrointestinal bleeding (64.4% vs. 60.6%). There were no significant differences between anterograde and retrograde approaches in terms of the diagnostic yield (69.3% vs. 52.5%) and intervention rate (23.8% vs. 17.2%). The procedure time was shorter for anterograde SBE than for retrograde SBE (68.1 ± 23.9 vs. 76.8 ± 27.7 min, P = 0.018). In addition, among the subgroup of patients with obscure gastrointestinal bleeding, the most common etiologies for those in different age-groups were angiodysplasia (≥ 65 years), non-specific ulcers (30–64 years), and Meckel’s diverticulum (< 30 years). The major complication rate during the study was 1.5%; the rate of asymptomatic hyperamylasemia was higher for patients who underwent anterograde SBE than for those who underwent retrograde SBE (13.9% vs. 2%, P = 0.005). The outcome and safety of anterograde and retrograde SBE are similar. However, anterograde SBE has a shorter procedural time and a higher rate of asymptomatic hyperamylasemia. PMID:27548619

  5. Endoscopic ultrasound-guided biliary drainage as an alternative to percutaneous drainage and surgical bypass.

    PubMed

    Prachayakul, Varayu; Aswakul, Pitulak

    2015-01-16

    Endoscopic retrograde cholangiopancreatography had been a treatment modality of choice for both benign and malignant biliary tract obstruction for more than half century, with a very high clinical success rate and low complications. But in certain circumstances, such as advanced and locally advanced pancreatobiliary malignancies (pancreatic cancer, cholangiocarcinoma, ampullary tumor) and tight benign strictures, endoscopic retrograde cholangiopancreatography (ERCP) fails. Up to this point, the only alternative interventions for these conditions were percutaneous transhepatic biliary drainage or surgery. Endoscopic ultrasound guided interventions was introduced for a couple decades with the better visualization and achievement of the pancreatobiliary tract. And it's still in the process of ongoing development. The inventions of new techniques and accessories lead to more feasibility of high-ended procedures. Endoscopic ultrasound guided biliary drainage was a novel treatment modality for the patient who failed ERCP with the less invasive technique comparing to surgical bypass. The technical and clinical success was high with acceptable complications. Regarded the ability to drain the biliary tract internally without an exploratory laparotomy, this treatment modality became a very interesting procedures for many endosonographers, worldwide, in a short period. We have reviewed the literature and suggest that endoscopic ultrasound-guided biliary drainage is also an option, and one with a high probability of success, for biliary drainage in the patients who failed conventional endoscopic drainage. PMID:25610532

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

    PubMed Central

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

    2016-01-01

    Starch retrogradation is a term used to define the process in which gelatinized starch undergoes a disorder-to-order transition. A thorough understanding of starch retrogradation behavior plays an important role in maintaining the quality of starchy foods during storage. By means of DSC, we have demonstrated for the first time that at low water contents, the enthalpy change of retrograded starch is higher than that of native starch. In terms of FTIR and Raman spectroscopic results, we showed that the molecular order of reheated retrograded starch samples is lower than that of DSC gelatinized starch. These findings have led us to conclude that enthalpy change of retrograded starch at low water contents involves the melting of recrystallized starch during storage and residual starch crystallites after DSC gelatinization, and that the endothermic transition of retrograded starch gels at low water contents does not fully represent the retrogradation behavior of starch. Very low or high water contents do not favor the occurrence of starch retrogradation. PMID:26860788

  7. Endoscopic Evaluation of Swallowing (Endoscopy)

    MedlinePlus

    ... the Public / Speech, Language and Swallowing / Swallowing Endoscopic Evaluation of Swallowing (Endoscopy) Do you have problems swallowing? ... Some names you might hear are: Endoscopy Endoscopic Evaluation of swallowing FEES (Fiberoptic Endoscopic Evaluation of Swallowing) ...

  8. Efficacy and Safety of Pancreatobiliary Endoscopic Procedures during Pregnancy

    PubMed Central

    Lee, Jae Joon; Lee, Sung Koo; Kim, Sang Hyung; Kim, Ga Hee; Park, Do Hyun; Lee, Sangsoo; Seo, Dongwan; Kim, Myung-Hwan

    2015-01-01

    Background/Aims Endoscopic therapy with endoscopic retrograde cholangiopancreatography (ERCP) has been suggested as an effective diagnostic and therapeutic tool for biliary and pancreatic disorders during pregnancy. In this report, we describe our experiences with pancreatobiliary endoscopic procedures during pregnancy. Methods We reviewed ERCP and endoscopic ultrasonography (EUS) procedures that were performed at a single tertiary care referral center between January 2002 and October 2013. Medical records were reviewed for the procedure indication, the duration of fluoroscopy, postprocedure complications, etc. Pregnancy outcomes and fetal complications were identified by chart review and phone calls to patients. Results A total of 10 ER-CPs and five EUSs were performed in 13 pregnant patients: four of whom underwent the procedure in the first trimester, eight in the second trimester, and one in the third trimester. Indications for endoscopic therapy included gallstone pancreatitis, obstructive jaundice with common bile duct (CBD) stone, asymptomatic CBD stone, pancreatic cyst, choledochal cyst, and acute cholecystitis. Only one patient had a complication, which was postprocedural hyperamylasemia. Two patients underwent an artificial abortion, one according to her own decision and the other due to an adverse drug reaction. Conclusions ERCP seems to be effective and safe for pregnant women. Additionally, EUS can be an alternative to ERCP during pregnancy. PMID:26087783

  9. Mirizzi Syndrome with Endoscopic Ultrasound Image

    PubMed Central

    Rayapudi, K.; Gholami, P.; Olyaee, M.

    2013-01-01

    We describe a 66-year-old Caucasian man with type 1 Mirizzi syndrome diagnosed on endoscopic ultrasound. He presented with acute onset of jaundice, malaise, dark urine over 3–4 days, and was found to have obstructive jaundice on lab testing. CT scan of the abdomen showed intrahepatic biliary ductal dilation, a 1.5 cm common bile duct (CBD) above the pancreas, and possible stones in the CBD, but no masses. Endoscopic retrograde cholangiopancreatography (ERCP) by a community gastroenterologist 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. PMID:23741207

  10. Endoscopic radiofrequency ablation for malignant biliary strictures

    PubMed Central

    WANG, FEI; LI, QUANPENG; ZHANG, XIUHUA; JIANG, GUOBING; GE, XIANXIU; YU, HONG; NIE, JUNJIE; JI, GUOZHONG; MIAO, LIN

    2016-01-01

    Endoscopic radiofrequency ablation (RFA) is a novel palliation therapy for malignant biliary stricture; however, its feasibility and safety has not yet been clearly defined. The aim of the present study was to evaluate the feasibility and safety of endoscopic RFA for the treatment of malignant biliary strictures. A total of 12 patients treated by endoscopic RFA between December 2011 and October 2013 were retrospectively analyzed. Adverse events within 30 days post-intervention, stricture diameters prior to and following RFA, stent patency and survival time were investigated. A total of 12 patients underwent 20 RFA procedures as a treatment for malignant biliary strictures. Two patients required repeated elective RFA (4 and 6 times, respectively). All 20 RFA procedures were successfully performed without technical problems. During a 30 day period following each RFA procedure, two patients experienced fever (38.2 and 38.9°C, respectively) and another patient exhibited post-endoscopic retrograde cholangiopancreatography pancreatitis. The 30- and 90-day mortality rates were 0 and 8.3%, respectively. Mean stricture diameter prior to RFA was 5.3 mm (standard deviation (SD), 0.9 mm; range, 5–8 mm), and the mean diameter following RFA was 12.6 mm (SD, 3.1 mm; range, 8–15 mm). There was a significant increase of 7.3 mm in the bile duct diameter following RFA in comparison with prior to RFA (t=8.6; P≤0.001). Of the 11 patients with stents inserted following RFA, the median stent patency was 125.0 days [95% confidence interval (CI), 94.7–155.3 days]. Extrapolated median survival following the first RFA was 232 days (95% CI, 94.3–369.7 days). In conclusion, RFA appears to be an efficient and safe treatment strategy for the palliation of unresectable malignant biliary strictures. PMID:27284336

  11. Process for forming retrograde profiles in silicon

    DOEpatents

    Weiner, Kurt H.; Sigmon, Thomas W.

    1996-01-01

    A process for forming retrograde and oscillatory profiles in crystalline and polycrystalline silicon. The process consisting of introducing an n- or p-type dopant into the silicon, or using prior doped silicon, then exposing the silicon to multiple pulses of a high-intensity laser or other appropriate energy source that melts the silicon for short time duration. Depending on the number of laser pulses directed at the silicon, retrograde profiles with peak/surface dopant concentrations which vary from 1-1e4 are produced. The laser treatment can be performed in air or in vacuum, with the silicon at room temperature or heated to a selected temperature.

  12. Process for forming retrograde profiles in silicon

    DOEpatents

    Weiner, K.H.; Sigmon, T.W.

    1996-10-15

    A process is disclosed for forming retrograde and oscillatory profiles in crystalline and polycrystalline silicon. The process consisting of introducing an n- or p-type dopant into the silicon, or using prior doped silicon, then exposing the silicon to multiple pulses of a high-intensity laser or other appropriate energy source that melts the silicon for short time duration. Depending on the number of laser pulses directed at the silicon, retrograde profiles with peak/surface dopant concentrations which vary are produced. The laser treatment can be performed in air or in vacuum, with the silicon at room temperature or heated to a selected temperature.

  13. Causes of retrograde flow in fish keratocytes.

    PubMed

    Fuhs, Thomas; Goegler, Michael; Brunner, Claudia A; Wolgemuth, Charles W; Kaes, Josef A

    2014-01-01

    Confronting motile cells with obstacles doubling as force sensors we tested the limits of the driving actin and myosin machinery. We could directly measure the force necessary to stop actin polymerization as well as the force present in the retrograde actin flow. Combined with detailed measurements of the retrograde flow velocity and specific manipulation of actin and myosin we found that actin polymerization and myosin contractility are not enough to explain the cells behavior. We show that ever-present depolymerization forces, a direct entropic consequence of actin filament recycling, are sufficient to fill this gap, even under heavy loads. PMID:24127260

  14. External security stitch for retrograde cardioplegia cannula.

    PubMed

    Gabbieri, Davide; Pedulli, Marco; Bianchi, Tiziano; Ghidoni, Italo

    2009-01-01

    Retrograde cardioplegia catheter displacement represents a troublesome complication, frequently forcing the surgeon to interrupt the operative procedure and cannulate newly the coronary sinus. However, this maneuver is time consuming, often implies the loss of surgical exposure, and exposes again the coronary sinus to the risk of iatrogenic injuries. We describe the use of an external security stitch through the muscular right atrial wall to avoid the displacement of a retrograde cardioplegia catheter and analyze the anatomic conditions which predispose to this complication. PMID:19583611

  15. Endoscopic Skull Base Surgery

    PubMed Central

    Senior, Brent A

    2008-01-01

    Endoscopic skull base surgery has undergone rapid advancement in the past decade moving from pituitary surgery to suprasellar lesions and now to a myriad of lesions extending from the cribriform plate to C2 and laterally out to the infratemporal fossa and petrous apex. Evolution of several technological advances as well as advances in understanding of endoscopic anatomy and the development of surgical techniques both in resection and reconstruction have fostered this capability. Management of benign disease via endoscopic methods is largely accepted now but more data is needed before the controversy on the role of endoscopic management of malignant disease is decided. Continued advances in surgical technique, navigation systems, endoscopic imaging technology, and robotics assure continued brisk evolution in this expanding field. PMID:19434274

  16. Endoscopic Devices for Obesity.

    PubMed

    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. PMID:27115879

  17. Retrograde Lymphatic Spread of Esophageal Cancer

    PubMed Central

    Oshiro, Hisashi; Osaka, Yoshiaki; Tachibana, Shingo; Aoki, Takaya; Tsuchiya, Takayoshi; Nagao, Toshitaka

    2015-01-01

    Abstract The concept of the retrograde lymphatic spread of cancer cells appears to account for a subset of the essential mechanisms of cancer metastasis in various organs. However, no adequate data currently exist to illustrate the pathology of the retrograde lymphatic metastasis of cancer cells in human bodies. To shed light on this phenomenon, we report a case of a 63-year-old Japanese man who underwent an esophagectomy and lymph node dissection for early-stage esophageal cancer. The patient's clinical information was evaluated by board-certified surgeons and internists. Surgically excised materials were histopathologically evaluated by attending pathologists. Postoperative pathological examination revealed that the patient's tumor was a well-differentiated squamous cell carcinoma with negative surgical margins (T1N0M0, stage I). Apart from the primary lesion, a single lymphatic vessel invasion was found between the lamina propria and lamina muscularis of the esophagus where intralymphatic cancer cells had spread against the direction of backflow prevention valves and skipped beyond these valves without destroying them. The present case demonstrated that the retrograde lymphatic spread of cancer cells can occur in valve-equipped lymphatic vessels. Our study may not only provide a scientific basis for the concept of retrograde lymphatic metastasis but also explain a portion of the complexities associated with the lymphogenous metastasis of esophageal cancer. PMID:26166121

  18. [Endoscopic ultrasound-guided choledocho-duodenostomy in advanced pancreatic cancer with duodenal obstruction].

    PubMed

    Mella, José Manuel; Guidi, Martín; De María, Julio; Hwang, Hui-Jer; Curvale, Cecilia R; Matano, Raúl

    2015-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is considered the first-approach for biliary drainage. In cases of ERCP failure, patients are usually referred for percutaneous transhepatic biliary drainage or surgical biliary bypass. In the last decade, the indications of endoscopic ultrasound (EUS) in the management of patients with pancreatic cancer have increased, and numerous cases of EUS-guided biliary drainage have been reported in patients with failures during the ERCP. Our goal is to report a patient with locally advanced pancreatic cancer who presented with painless jaundice and cholestasis with biliary and duodenal obstruction. A EUS-guided choledochoduodenostomy was performed by placement of a self-expanding metal stent. PMID:26502467

  19. Endoscopic Ultrasound-guided Antegrade Stenting in an Occluded Biliary Self-expandable Metal Stent

    PubMed Central

    Almadi, Majid A.; Eltayeb, Mohanned; Thaniah, Salem

    2016-01-01

    Endoscopic ultrasound-guided biliary drainage (EUS-BD) is an attractive option for patients who cannot undergo conventional endoscopic retrograde cholangiopancreatography (ERCP) and do not want surgery or percutaneous drainage procedures. We present the use of EUS-antegrade (EUS-AG) insertion of a self-expandable metal stent (SEMS) in a patient with a common hepatic duct cholangiocarcinoma, as well as a huge gastric lipoma, after recurrent biliary obstruction of a prior SEMS inserted via ERCP in the same session as a duodenal stent insertion for gastric outlet obstruction. PMID:27488330

  20. Combined Endoscopic and Percutaneous Retrieval of a Retained 4-Wire Ureteral Stone Basket

    PubMed Central

    Kaplan, Adam G.; Preminger, Glenn M.

    2015-01-01

    Abstract Complex endourologic procedures may require the use of a combined ureteroscopic and percutaneous approach. Endoscopic removal of a retained 4-wire ureteral stone basket is particularly complex, as broken tines can potentially injure the ureter if the basket is removed in a retrograde manner. The patient in this case presented with a ureteral stone basket embedded within the urothelium of the upper pole of the kidney. Holmium laser incision of the overlying urothelium allowed retrieval of the basket, although the tines were broken. Endoscopically guided percutaneous access to the kidney was obtained to allow for direct passage of the retained basket out of a nephrostomy sheath, thereby protecting the kidney.

  1. Current applications of endoscopic suturing

    PubMed Central

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

    2015-01-01

    Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo OverStitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty. PMID:26191342

  2. Delayed Severe Hemobilia after Endoscopic Biliary Plastic Stent Insertion

    PubMed Central

    Lee, Sung Hak; Hong, Seung Goun; Lee, Kyoung yong; Park, Pyung Kang; Kim, Sung Du; Lee, Mahn; Yu, Dong Wook; Hong, Man Yong

    2016-01-01

    Hemobilia is a rare gastrointestinal bleeding, usually caused by injury to the bile duct. Hemobilia after endoscopic retrograde cholangiopancreatography (ERCP) is generally self-limiting and patients will spontaneously recover, but some severe and fatal hemorrhages have been reported. ERCP-related bowel or bile duct perforation should be managed promptly, according to the type of injury and the status of the patient. We recently experienced a case of late-onset severe hemobilia in which the patient recovered after endoscopic biliary stent insertion. The problem was attributable to ERCP-related bile duct perforation during stone removal, approximately 5 weeks prior to the hemorrhagic episode. The removal of the stent was performed 10 days before the onset of hemobilia. The bleeding was successfully treated by two sessions of transarterial coil embolization. PMID:27012288

  3. Endoscopic Bariatric Therapies.

    PubMed

    Goyal, Deepinder; Watson, Rabindra R

    2016-06-01

    Obesity and its associated cardio-metabolic comorbidities have emerged as a global pandemic. The efficacy of various hypo-caloric diets and prescription drugs has been poor with respect to sustained weight loss. Recent advancements in endoscopic technology and techniques have opened a new field of minimally invasive endoscopic treatment options for combatting obesity both as a first line and adjunctive therapy. Presently, two endoscopic space-occupying devices in the form of intragastric balloons have received FDA approval for 6-month implantation in patients within a BMI range of 30-40 kg/m(2). Furthermore, full-thickness suturing has led to the development of primary endoscopic sleeve gastroplasty and Roux-en-Y gastric bypass revision as viable endoscopic alternatives to surgical approaches. These techniques have the potential to reduce adverse events, cost, and recovery times. Looking forward, a variety of promising and novel medical devices and endoscopic platforms that target obesity and diabetes are in various phases of development and investigation. The present review aims to discuss the current and forthcoming endoscopic bariatric therapies with emphasis on relevant procedural technique and review of available evidence. PMID:27098813

  4. Endoscopic Electrosurgery in Patients with Cardiac Implantable Electronic Devices

    PubMed Central

    Baeg, Myong Ki; Kim, Sang-Woo; Ko, Sun-Hye; Lee, Yoon Bum; Hwang, Seawon; Lee, Bong-Woo; Choi, Hye Jin; Park, Jae Myung; Lee, In-Seok; Oh, Yong-Seog; Choi, Myung-Gyu

    2016-01-01

    Background/Aims: Patients with cardiac implantable electronic devices (CIEDs) undergoing endoscopic electrosurgery (EE) are at a risk of electromagnetic interference (EMI). We aimed to analyze the effects of EE in CIED patients. Methods: Patients with CIED who underwent EE procedures such as snare polypectomy, endoscopic submucosal dissection (ESD), and endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) were retrospectively analyzed. Postprocedural symptoms as well as demographic and outpatient follow-up data were reviewed through medical records. Electrical data, including preprocedural and postprocedural arrhythmia records, were reviewed through pacemaker interrogation, 24-hour Holter monitoring, or electrocardiogram. Results: Fifty-nine procedures in 49 patients were analyzed. Fifty procedures were performed in 43 patients with a pacemaker, and nine were performed in six patients with an implantable cardioverter-defibrillator. There were one gastric and 44 colon snare polypectomies, five gastric and one colon ESDs, and eight ERCPs with EST. Fifty-five cases of electrical follow-up were noted, with two postprocedural changes not caused by EE. Thirty-one pacemaker interrogations had procedure recordings, with two cases of asymptomatic tachycardia. All patients were asymptomatic with no adverse events. Conclusions: Our study reports no adverse events from EE in patients with CIED, suggesting that this procedure is safe. However, because of the possibility of EMI, recommendations on EE should be followed. PMID:26867552

  5. Endoscopic examination of snakes by access through an air sac.

    PubMed

    Jekl, V; Knotek, Z

    2006-03-25

    Sixteen boa constrictors (Boa constrictor), three royal pythons (Python regius) and 15 Burmese pythons (Python molurus bivittatus) were examined endoscopically by access through the air sac. The snakes were immobilised in a ventral position using a half-open anaesthetic system with assisted ventilation and a mixture of isoflurane and oxygen. The rigid endoscope was introduced percutaneously and the internal structure of the lungs and the air sac, and the shape, size and external surface of the liver were visible in the cranial direction. In the smaller snakes the bifurcation and caudal part of the trachea could be viewed, provided the endoscope was positioned in a retrograde orientation. The caudal orientation of the endoscope made it possible to view the gall bladder and the size, shape and surface of the spleen. In some cases, the pancreas and the surface of the stomach and colon could be monitored. Endoscopy through the air sac also made it possible to check the major veins in the coelom. The snakes were monitored for at least 30 days after the intervention and no changes in their respiratory function or general health were observed. PMID:16565339

  6. Endoscopic treatment of gastroparesis

    PubMed Central

    McCarty, Thomas R; Rustagi, Tarun

    2015-01-01

    Gastroparesis has traditionally been a largely medically managed disease with refractory symptoms typically falling under the umbrella of the surgical domain. Surgical options include, but are not limited to, gastrostomy, jejunostomy, pyloromyotomy, or pyloroplasty, and the Food and Drug Administration approved gastric electrical stimulation implantation. Endoscopic management of gastroparesis most commonly involves intrapyloric botulinum toxin injection; however, there exists a variety of endoscopic approaches on the horizon that have the potential to radically shift standard of care. Endoscopic management of gastroparesis seeks to treat delayed gastric emptying with a less invasive approach compared to the surgical approach. This review will serve to highlight such innovative and potentially transformative, endoscopic interventions available to gastroenterologists in the management of gastroparesis. PMID:26078560

  7. Understanding EUS (Endoscopic Ultrasonography)

    MedlinePlus

    ... Certification (MOC) Course Calendar GI Outlook (GO) Practice Management Conference Endoscopic Learning Library IT&T Hands-On Training Training and ... ASGE Endorsed Activities Ambassador Program Trainee Resources Traveling Learning ... MANAGEMENT GI Outlook (GO) Practice Management Conference Featured Courses ...

  8. Effect of vinpocetine on retrograde axoplasmic transport.

    PubMed

    Knyihar-Csillik, Elizabeth; Vecsei, Laszlo; Mihaly, Andras; Fenyo, Robert; Farkas, Ibolya; Krisztin-Peva, Beata; Csillik, Bertalan

    2007-01-01

    Vinpocetine, a derivate of vincamine, is widely used in the clinical pharmacotherapy of cerebral circulatory diseases. Herewith we report on a novel effect of vinpocetine: inhibition of retrograde axoplasmic transport of nerve growth factor (NGF) in the peripheral nerve. Blockade of retrograde transport of NGF results in transganglionic degenerative atrophy (TDA) in the segmentally related ipsilateral superficial spinal dorsal horn, which is characterized by depletion of the marker enzymes fluoride-resistant acid phosphatase (FRAP) and thiamine monophosphatase (TMP). At the same time, pain-related neuropeptides such as substance P (SP) and calcitonin gene-related peptide (CGRP), are depleted from lamina I-III from the segmentally related, ipsitateral Rolando substance of the spinal cord. On the basis of these experiments it is suggested that vinpocetine may result in a locally restricted decrease of nociception, that might be useful in clinical treatment of intractable pain. Pilot self-experiments support this assumption. PMID:17319607

  9. Evaluation of early endoscopic realignment of post-traumatic complete posterior urethral rupture

    PubMed Central

    Abdelsalam, Yaser M; Abdalla, Medhat A; Safwat, Ahmad S; ElGanainy, Ehab O

    2013-01-01

    Introduction: to report our experience with 41 patients treated by early endoscopic realignment of complete post-traumatic rupture urethra. Materials and Methods: The study includes patients presented to our institute, between May 2004 and April 2009, with post-traumatic complete posterior urethral disruption. Preoperative retrograde urethrography, voiding cystourethrography and abdominopelvic CT were performed to evaluate the urethral defect length, the bladder neck competence, the prostate position, and the extent of the pelvic hematoma. Within the first week after trauma, antegrade and retrograde urethroscopy were performed to identify both urethral ends and insert urethral catheter. Patients were followed up by pericatheter retrograde urethrogram monthly postoperatively till catheter removal on disappearance of extravasation. Retrograde urethrography, voiding cystourethrography and urethroscopy were performed 1 month after the removal of the catheter. Follow-up abdominal ultrasound and uroflowmetry monthly till 6 months, bimonthly till 1 year, and every 3 months thereafter were encouraged. Urinary continence and postoperative erectile dysfunction were assessed by direct patient interview. Results: Forty one patients in the age group 17-61 years (mean 37.9) were treated. Patients were followed up for Conclusions: Early endoscopic realignment for complete posterior urethral rupture is a feasible technique with no or minimal intraoperative complications. The technique is successful as the definitive line of therapy in reasonable number of patients and seems to render further future interventions for inevitable urethral stricture easier. PMID:24082438

  10. Endoscopic Techniques in Tympanoplasty.

    PubMed

    Anzola, Jesus Franco; Nogueira, João Flávio

    2016-10-01

    The endoscope has transformed the way we observe, understand, and treat chronic ear disease. Improved view, exclusive transcanal techniques, assessment of ventilation routes and mastoid tissue preservation have led to decreased morbidity and functional enhancement of minimally invasive reconstruction of the middle ear. The philosophical identity of endoscopic ear surgery is evolving; new research, long-term results, and widespread acknowledgement of its postulates will undoubtedly define its role in otology. PMID:27565390

  11. Standardized endoscopic reporting.

    PubMed

    Aabakken, Lars; Barkun, Alan N; Cotton, Peter B; Fedorov, Evgeny; Fujino, Masayuki A; Ivanova, Ekaterina; Kudo, Shin-Ei; Kuznetzov, Konstantin; de Lange, Thomas; Matsuda, Koji; Moine, Olivier; Rembacken, Björn; Rey, Jean-Francois; Romagnuolo, Joseph; Rösch, Thomas; Sawhney, Mandeep; Yao, Kenshi; Waye, Jerome D

    2014-02-01

    The need for standardized language is increasingly obvious, also within gastrointestinal endoscopy. A systematic approach to the description of endoscopic findings is vital for the development of a universal language, but systematic also means structured, and structure is inherently a challenge when presented as an alternative to the normal spoken word. The efforts leading to the "Minimal Standard Terminology" (MST) of gastrointestinal endoscopy offer a standardized model for description of endoscopic findings. With a combination of lesion descriptors and descriptor attributes, this system gives guidance to appropriate descriptions of lesions and also has a normative effect on endoscopists in training. The endoscopic report includes a number of items not related to findings per se, but to other aspects of the procedure, formal, technical, and medical. While the MST sought to formulate minimal lists for some of these aspects (e.g. indications), they are not all well suited for the inherent structure of the MST, and many are missing. Thus, the present paper offers a recommended standardization also of the administrative, technical, and other "peri-endoscopic" elements of the endoscopic report; important also are the numerous quality assurance initiatives presently emerging. Finally, the image documentation of endoscopic findings is becoming more obvious-and accessible. Thus, recommendations for normal procedures as well as for focal and diffuse pathology are presented. The recommendations are "minimal," meaning that expansions and subcategories will likely be needed in most centers. Still, with a stronger common grounds, communication within endoscopy will still benefit. PMID:24329727

  12. Endoscopic video manifolds.

    PubMed

    Atasoy, Selen; Mateus, Diana; Lallemand, Joe; Meining, Alexander; Yang, Guang-Zhong; Navab, Nassir

    2010-01-01

    Postprocedural analysis of gastrointestinal (GI) endoscopic videos is a difficult task because the videos often suffer from a large number of poor-quality frames due to the motion or out-of-focus blur, specular highlights and artefacts caused by turbid fluid inside the GI tract. Clinically, each frame of the video is examined individually by the endoscopic expert due to the lack of a suitable visualisation technique. In this work, we introduce a low dimensional representation of endoscopic videos based on a manifold learning approach. The introduced endoscopic video manifolds (EVMs) enable the clustering of poor-quality frames and grouping of different segments of the GI endoscopic video in an unsupervised manner to facilitate subsequent visual assessment. In this paper, we present two novel inter-frame similarity measures for manifold learning to create structured manifolds from complex endoscopic videos. Our experiments demonstrate that the proposed method yields high precision and recall values for uninformative frame detection (90.91% and 82.90%) and results in well-structured manifolds for scene clustering. PMID:20879345

  13. Are Wnts Retrogradely Transported to the ER?

    PubMed

    Tang, Bor Luen

    2016-11-01

    A recent report showed that Drosophila miR-307a initiates endoplasmic reticulum (ER) stress in wingless (wg)-expressing cells by suppression of the evolutionarily conserve Wnt secretion factor Wntless (Wls). Interestingly, the authors noted that wg has a putative C-terminal dilysine motif (KKVY), which is required for its apparent retrograde Golgi-to-ER transport. Wls suppression resulted in ER stress, which was phenocopied by several other manipulations that impaired wg secretion in flies, as well as Wnt5a secretion in mammalian cells. The authors surmised that their data "reveals a previously unknown Golgi-to-ER retrograde route of wg, and elucidates a correlation between Wnt secretion and ER stress." However, there are obvious caveats to this interpretation, as ER stress resulting from Wnt secretion impairment could be readily explained by its inability to leave the ER, and not resulting from Golgi-to-ER retrograde transport. J. Cell. Physiol. 231: 2315-2316, 2016. © 2016 Wiley Periodicals, Inc. PMID:26916992

  14. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma

    PubMed Central

    Kawakubo, Kazumichi; Kawakami, Hiroshi; Kuwatani, Masaki; Haba, Shin; Kudo, Taiki; Taya, Yoko A; Kawahata, Shuhei; Kubota, Yoshimasa; Kubo, Kimitoshi; Eto, Kazunori; Ehira, Nobuyuki; Yamato, Hiroaki; Onodera, Manabu; Sakamoto, Naoya

    2016-01-01

    AIM: To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma. METHODS: In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage. RESULTS: In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage. CONCLUSION: The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications. PMID:27170839

  15. Biliary hemostasis using an endoscopic plastic stent placement for uncontrolled hemobilia caused by transpapillary forceps biopsy (with video).

    PubMed

    Shinjo, Kunihiro; Matsubayashi, Hiroyuki; Matsui, Toru; Kawata, Noboru; Uemura, Sunao; Yamamoto, Yusuke; Ono, Hiroyuki

    2016-04-01

    A 78-year-old woman was referred to our hospital for the examination and treatment of jaundice. A transpapillary forceps biopsy for a long distal bile duct stricture was performed using endoscopic retrograde cholangiopancreatography. Immediately after the biopsy, massive bleeding was observed from the orifice of the papilla. Although hemobilia was pulsatile, an endoscopic biliary plastic stent placement was very effective in achieving hemostasis. However, a nasal biliary catheter was required because a blood clot clogged the stent on the following day. Although covered self-expandable metal stent (CSEMS) placement has been reported for achieving endoscopic hemostasis for bleeding, we chose to use a plastic stent to reduce the risk of post-procedure pancreatitis. The placement of both an endoscopic biliary plastic stent and a nasobiliary drainage catheter can be an alternative hemostatic tool to CSEMSs. PMID:26960930

  16. Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis.

    PubMed

    Ha, Ji Su; Choi, Hyun Jong; Moon, Jong Ho; Lee, Yun Nah; Tae, Jae Woong; Choi, Moon Han; Lee, Tae Hoon; Cha, Sang-Woo

    2015-11-01

    Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis. PMID:26668810

  17. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis.

    PubMed

    Minaga, Kosuke; Kitano, Masayuki; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Kadosaka, Kumpei; Yoshikawa, Tomoe; Kudo, Masatoshi

    2016-04-28

    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. PMID:27122677

  18. Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis

    PubMed Central

    Ha, Ji Su; Choi, Hyun Jong; Moon, Jong Ho; Lee, Yun Nah; Tae, Jae Woong; Choi, Moon Han; Lee, Tae Hoon; Cha, Sang-Woo

    2015-01-01

    Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis. PMID:26668810

  19. Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Miyata, Takeshi; Omoto, Shunsuke; Kadosaka, Kumpei; Yoshikawa, Tomoe; Kudo, Masatoshi

    2016-01-01

    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. PMID:27122677

  20. Endoscopic management of choledochocele complicated with choledocholithiasis and pancreatitis in an old patient.

    PubMed

    Zhu, Liang; Zeng, Hao; Chen, You-Xiang; Lu, Nong-Hua

    2015-02-01

    Choledochocele, or type III choledochal cyst, is a rare congenital disease and is even less common among adults compared with children. In this case, a 75-year-old female was admitted to our hospital presented with epigastric pain and vomiting for one day. Abdominal computed tomography revealed dilated common bile duct, pancreatitis and peripancreatic effusion. The patient was treated with fasting, fluid resuscitation, anti-acid agents, somatostatin and antibiotics. Endoscopic retrograde cholangiopancreatography was employed for the further diagnosis of choledochocele, choledocholithiasis and biliary stenosis. Endoscopic sphincterotomy, stone extraction and plastic stent placement were performed for treatment. The patient recovered quickly after the treatment and no signs of recurrence and complications were observed during the first follow-up. Endoscopic management may be a promising and alternative therapy for choledochocele although long-term follow-up is necessary to confirm the efficacy and safety of this procedure in the future. PMID:24859881

  1. Sparse aperture endoscope

    DOEpatents

    Fitch, Joseph P.

    1999-07-06

    An endoscope which reduces the volume needed by the imaging part thereof, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases the utility thereof. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing.

  2. Sparse aperture endoscope

    DOEpatents

    Fitch, J.P.

    1999-07-06

    An endoscope is disclosed which reduces the volume needed by the imaging part, maintains resolution of a wide diameter optical system, while increasing tool access, and allows stereographic or interferometric processing for depth and perspective information/visualization. Because the endoscope decreases the volume consumed by imaging optics such allows a larger fraction of the volume to be used for non-imaging tools, which allows smaller incisions in surgical and diagnostic medical applications thus produces less trauma to the patient or allows access to smaller volumes than is possible with larger instruments. The endoscope utilizes fiber optic light pipes in an outer layer for illumination, a multi-pupil imaging system in an inner annulus, and an access channel for other tools in the center. The endoscope is amenable to implementation as a flexible scope, and thus increases it's utility. Because the endoscope uses a multi-aperture pupil, it can also be utilized as an optical array, allowing stereographic and interferometric processing. 7 figs.

  3. Flexible endoscopes: structure and function--the air and water system.

    PubMed

    Holland, P; Shoop, N

    2000-01-01

    Flexible endoscopes are complex medical instruments that are easily damaged. To maintain the flexible endoscope in optimum working condition, the user must have a thorough understanding of the structure and function of the instrument. This series of articles will present an in-depth look at the care and handling of these expensive devices. The flexible endoscope is constructed of several systems that operate simultaneously to produce a highly technical, yet effective diagnostic and therapeutic medical device. These systems include the air and water system, the suction and operating channel system, the mechanical system, the endoscopic retrograde cholangiopancreatography (ERCP) elevator system, the optical system, and the electrical system. This first article in a series will focus on the air and water system of the endoscope. A review of the internal and external structure of the flexible endoscope and the functions of the air and water system, including infection control issues, potential problems and evaluation, and prevention of minor problems to avoid expensive repairs, will be addressed. PMID:11854970

  4. Mitochondrial emitted electromagnetic signals mediate retrograde signaling.

    PubMed

    Bagkos, Georgios; Koufopoulos, Kostas; Piperi, Christina

    2015-12-01

    Recent evidence shows that mitochondria regulate nuclear transcriptional activity both in normal and cell stress conditions, known as retrograde signaling. Under normal mitochondrial function, retrograde signaling is associated with mitochondrial biogenesis, normal cell phenotype and metabolic profile. In contrast, mitochondrial dysfunction leads to abnormal (oncogenic) cell phenotype and altered bio-energetic profile (nucleus reprogramming). Despite intense research efforts, a concrete mechanism through which mitochondria determine the group of genes expressed by the nucleus is still missing. The present paper proposes a novel hypothesis regarding retrograde signaling. More specifically, it reveals the mitochondrial membrane potential (MMP) and the accompanied strong electromagnetic field (EF) as key regulatory factors of nuclear activity. Mitochondrial emitted EFs extend in long distance and affect the function of nuclear membrane receptors. Depending on their frequencies, EFs can directly activate or deactivate different groups of nuclear receptors and so determine nuclear gene expression. One of the key features of the above hypothesis is that nuclear membrane receptors, besides their own endogenous or chemical ligands (hormones, lipids, etc.), can also be activated by electromagnetic signals. Moreover, normal MMP values (about -140 mV) are associated with the production of high ATP quantities and small levels of reactive oxygen species (ROS) while the hyperpolarization observed in all cancer cell types leads to a dramatic fall in ATP production and an analogous increase in ROS. The diminished ATP and increased ROS production negatively affect the function of all cellular systems including nucleus. Restoration of mitochondrial function, which is characterized by the fluctuation of MMP and EF values within a certain (normal) range, is proposed as a necessary condition for normal nuclear function and cancer therapy. PMID:26474928

  5. Mitochondrial Retrograde Signaling: Triggers, Pathways, and Outcomes

    PubMed Central

    da Cunha, Fernanda Marques; Torelli, Nicole Quesada; Kowaltowski, Alicia J.

    2015-01-01

    Mitochondria are essential organelles for eukaryotic homeostasis. Although these organelles possess their own DNA, the vast majority (>99%) of mitochondrial proteins are encoded in the nucleus. This situation makes systems that allow the communication between mitochondria and the nucleus a requirement not only to coordinate mitochondrial protein synthesis during biogenesis but also to communicate eventual mitochondrial malfunctions, triggering compensatory responses in the nucleus. Mitochondria-to-nucleus retrograde signaling has been described in various organisms, albeit with differences in effector pathways, molecules, and outcomes, as discussed in this review. PMID:26583058

  6. Transvaginal endoscopic appendectomy.

    PubMed

    Shin, Eung Jin; Jeong, Gui Ae; Jung, Jun Chul; Cho, Gyu Seok; Lim, Chul Wan; Kim, Hyung Chul; Song, Ok Pyung

    2010-12-01

    Since Kalloo and colleagues first reported the feasibility and safety of a peroral transgastric approach in the porcine model in 2004, various groups have reported more complex natural orifice transluminal endoscopic surgery (NOTES) procedures, such as the cholecystectomy, splenectomy and liver biopsy, in the porcine model. Natural orifice access to the abdominal cavity, such as transgastric, transvesical, transcolonic, and transvaginal, has been described. Although a novel, minimally invasive approach to the abdominal cavity is a peroral endoscopic transgastric approach, there are still some challenging issues, such as the risk of infection and leakage, and the method of gastric closure. Hybrid-NOTES is an ideal first step in humans. Human hybrid transvaginal access has been used for years by many surgeons for diagnostic and therapeutic purposes. Here, we report a transvaginal flexible endoscopic appendectomy, with a 5-mm umbilical port using ultrasonic scissors in a 74-year-old woman with acute appendicitis. PMID:21221245

  7. Technicalities of endoscopic biopsy.

    PubMed

    Tytgat, G N; Ignacio, J G

    1995-11-01

    Despite the wealth of biopsy forceps currently available, it is obvious that there are sufficient drawbacks and shortcomings to reconsider the overall design of the endoscopic biopsy depth, the short lifespan of reusable forceps, damage to the working channel, excessive time consumption, cleaning and disinfection difficulties, etc. Improvements should be possible that approach the same degree of sophistication as is currently available in endoscopic equipment. Fully-automated, repetitive, quickly targeted biopsy sampling should be possible, but it will require the utmost technical ingenuity and expertise to achieve. PMID:8903983

  8. Endoscopic Sedation: Medicolegal Considerations.

    PubMed

    Kralios, Andreas A; Feld, Kayla A; Feld, Andrew D

    2016-07-01

    Goals of endoscopic sedation are to provide patients with a successful procedure, and ensure that they remain safe and are relieved from anxiety and discomfort; agents should provide efficient, appropriate sedation and allow patients to recover rapidly. Sedation is usually safe and effective; however, complications may ensue. This paper outlines some medicolegal aspects of endoscopic sedation, including informed consent, possible withdrawal of consent during the procedure, standard of care for monitoring sedation, use of anesthesia personnel to deliver sedation, and new agents and devices. PMID:27372770

  9. Endoscopic Facial Nerve Surgery.

    PubMed

    Marchioni, Daniele; Soloperto, Davide; Rubini, Alessia; Nogueira, João Flávio; Badr-El-Dine, Mohamed; Presutti, Livio

    2016-10-01

    Tympanic facial nerve segment surgery has been traditionally performed using microscopic approaches, but currently, exclusive endoscopic approaches have been performed for traumatic, neoplastic, or inflammatory diseases, specially located at the geniculate ganglion, greater petrosal nerve, and second tract of the facial nerve, until the second genu. The tympanic segment of the facial nerve can be reached and visualized using an exclusive transcanal endoscopic approach, even in poorly accessible regions such as the second genu and geniculate ganglion, avoiding mastoidectomy, bony demolition, and meningeal or cerebral lobe tractions, with low complication rates using a minimally invasive surgical route. PMID:27468633

  10. Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: A review of current literature

    PubMed Central

    Martin, Aaron; Kistler, Charles Andrew; Wrobel, Piotr; Yang, Juliana F.; Siddiqui, Ali A.

    2016-01-01

    The management of pancreaticobiliary disease in patients with surgically altered anatomy is a growing problem for gastroenterologists today. Over the years, endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the treatment of pancreaticobiliary disease. Patient anatomy has become increasingly complex due to advances in surgical resection of pancreaticobiliary disease and EUS has emerged as the therapy of choice when endoscopic retrograde cholangiopancreatography failed cannulation or when the papilla is inaccessible such as in gastric obstruction or duodenal obstruction. The current article gives a comprehensive review of the current literature for EUS-guided intervention of the pancreaticobiliary tract in patients with altered surgical anatomy. PMID:27386471

  11. Outcomes Following Endoscopic Stapes Surgery.

    PubMed

    Hunter, Jacob B; Rivas, Alejandro

    2016-10-01

    There are limited studies describing the surgical and hearing outcomes following endoscopic stapes surgeries, despite the burgeoning interest and excitement in endoscopic ear surgery. Current studies have demonstrated that endoscopic stapes surgery is safe and has similar audiologic outcomes when compared with microscopic stapes procedures. However, preliminary studies show decreased postoperative pain in endoscopic cases compared with microscopic controls. In regards to possible endoscopic advantages, these few studies demonstrate mixed results when comparing the need to remove the bony medial external auditory canal wall to improve visualization and access to the oval window niche. PMID:27565387

  12. Retrograde intrarenal surgery in pediatric patients.

    PubMed

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

    2014-11-01

    Urinary tract stone disease is seen at a level of 1%-2% in childhood (< 18 years). In recent years, however, there has been a marked increased in pediatric stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to today's advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques. PMID:25374812

  13. Terminal retrograde turn of rolling rings

    NASA Astrophysics Data System (ADS)

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

    2015-09-01

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

  14. Terminal retrograde turn of rolling rings.

    PubMed

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

    2015-09-01

    We report an unexpected reverse spiral turn in the final stage of the motion of rolling rings. It is well known that spinning disks rotate in the same direction of their initial spin until they stop. While a spinning ring starts its motion with a kinematics similar to disks, i.e., moving along a cycloidal path prograde with the direction of its rigid body rotation, the mean trajectory of its center of mass later develops an inflection point so that the ring makes a spiral turn and revolves in a retrograde direction around a new center. Using high speed imaging and numerical simulations of models featuring a rolling rigid body, we show that the hollow geometry of a ring tunes the rotational air drag resistance so that the frictional force at the contact point with the ground changes its direction at the inflection point and puts the ring on a retrograde spiral trajectory. Our findings have potential applications in designing topologically new surface-effect flying objects capable of performing complex reorientation and translational maneuvers. PMID:26465546

  15. Subtrochanteric fractures after retrograde femoral nailing.

    PubMed

    Mounasamy, Varatharaj; Mallu, Sathya; Khanna, Vishesh; Sambandam, Senthil

    2015-10-18

    Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis. PMID:26495251

  16. Endoscopic ultrasound-guided biliary drainage of hilar biliary obstruction.

    PubMed

    Park, Do Hyun

    2015-09-01

    Only 20-30% of patients with hilar cholangiocarcinoma (CC) are candidates for potentially curative resection. However, even after curative (R0) resection, these patients have a disease recurrence rate of up to 76%. The prognosis of hilar cholangiocarcinoma (CC) is limited by tumor spread along the biliary tree leading to obstructive jaundice, cholangitis, and liver failure. Therefore, palliative biliary drainage may be a major goal for patients with hilar CC. Endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is an established method for palliation of patients with malignant biliary obstruction. However, there are patients for whom endoscopic stent placement is not possible because of failed biliary cannulation or tumor infiltration that limits transpapillary access. In this situation, percutaneous transhepatic biliary drainage (PTBD) is an alternative method. However, PTBD has a relatively high rate of complications and is frequently associated with patient discomfort related to external drainage. Endoscopic ultrasound-guided biliary drainage has therefore been introduced as an alternative to PTBD in cases of biliary obstruction when ERCP is unsuccessful. In this review, the indications, technical tips, outcomes, and the future role of EUS-guided intrahepatic biliary drainage, such as hepaticogastrostomy or hepaticoduodenostomy, for hilar biliary obstruction will be summarized. PMID:26178753

  17. Radiographer Delivered Fluoroscopy Reduces Radiation Exposure During Endoscopic Urological Procedures

    PubMed Central

    Hennessey, DB; Young, M; Pahuja, A

    2016-01-01

    Introduction The 1999 Ionising Radiation Regulations recommend that medical professionals using ionising radiation should aim to keep exposure as ‘low as reasonably practicable’. Urologists regularly use fluoroscopy during endoscopic surgical procedures. In some institutions, this is delivered by a radiographer whereas in others, it is delivered by the urological surgeon. Objectives To determine if radiographer-delivered fluoroscopy can reduce the exposure to ionising radiation during urological procedures. Methods An analysis of 395 consecutive patients, who underwent endoscopic urological procedures requiring fluoroscopy, was performed simultaneously across two institutions, over a 4 month period. 321 patients were matched and included in the analysis. Results Radiographer delivered fluoroscopy was associated with reduced ionising radiation exposure for retrograde pyelography procedures ED 0.09626 vs. 1.323 mSev, p= 0.0003, and endoscopic stone surgeries ED 0.3066 Vs. 0.5416 mSev, p=0.0039, but not for ureterorenoscopic stone surgeries 0.4880 vs. 0.2213 mSev, p=0.8292. Conclusion Radiographer delivered fluoroscopy could reduce the patient’s exposure to ionising radiation for some urological procedures. PMID:27158158

  18. Endoscopic Ultrasound Practice Survey in Latin America

    PubMed Central

    Drigo, Juliana Marques; Castillo, Cecilia; Wever, Wallia; Obaldía, José Ricardo Ruíz; Fillipi, Sheila; Ribeiro, Manoel C. S. A.; Rossini, Lucio G. B.

    2013-01-01

    Objective: Endoscopic ultrasound (EUS) has become an important imaging modality for the diagnosis, staging and treatment of gastrointestinal disorders. However, no official data exists regarding clinical EUS practice in Latin America (LA). This study assessed current EUS practice and training. Patients and Methods: A direct mail survey questionnaire was sent to 268 Capítulo Latino Americano de Ultrasonido Endoscópico members between August 2012 and January 2013. The questionnaire was sent out in English, Spanish and Portuguese languages and was available through the following site: http://www.cleus-encuesta.com. Responses were requested only from physicians who perform EUS. Results: A total of 70 LA physicians answered the questionnaire until January 2013. Most of the participants were under 42 years of age (53%) and 80% were men. Most participants (45.7%) perform EUS in Brazil, 53% work in a private hospital. The majority (70%) also perform endoscopic retrograde cholangiopancreatography. A total 42% had performed EUS for 2 years or less and 22.7% for 11 years or more. Only 10% performed more than 5000 EUS. The most common indication was an evaluation of pancreatic-biliary-ampullary lesions. Regarding training, 48.6% had more than 6 months of dedicated hands-on EUS and 37% think that at least 6 months of formal training is necessary to acquire competence. Furthermore, 64% think that more than 50 procedures for pancreatic-biliary lesions are necessary. Conclusion: This survey provides insight into the status of EUS in LA. EUS is performed mostly by young endoscopists in LA. Diagnostic upper EUS is the most common EUS procedure. Most endosonographers believe that formal training is necessary to acquire competence. PMID:24949398

  19. Evolving endoscopic surgery.

    PubMed

    Sakai, Paulo; Faintuch, Joel

    2014-06-01

    Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques. PMID:24628672

  20. Endoscopic Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Zhou, Chao; Fujimoto, James G.; Tsai, Tsung-Han; Mashimo, Hiroshi

    New gastrointestinal (GI) cancers are expected to affect more than 290,200 new patients and will cause more than 144,570 deaths in the United States in 2013 [1]. When detected and treated early, the 5-year survival rate for colorectal cancer increases by a factor of 1.4 [1]. For esophageal cancer, the rate increases by a factor of 2 [1]. The majority of GI cancers begin as small lesions that are difficult to identify with conventional endoscopy. With resolutions approaching that of histopathology, optical coherence tomography (OCT) is well suited for detecting the changes in tissue microstructure associated with early GI cancers. Since the lesions are not endoscopically apparent, however, it is necessary to survey a relatively large area of the GI tract. Tissue motion is another limiting factor in the GI tract; therefore, in vivo imaging must be performed at extremely high speeds. OCT imaging can be performed using fiber optics and miniaturized lens systems, enabling endoscopic OCT inside the human body in conjunction with conventional video endoscopy. An OCT probe can be inserted through the working channel of a standard endoscope, thus enabling depth-resolved imaging of tissue microstructure in the GI tract with micron-scale resolution simultaneously with the endoscopic view (Fig. 68.1).

  1. Endoscopic treatment of obesity

    PubMed Central

    Swidnicka-Siergiejko, Agnieszka; Wróblewski, Eugeniusz; Dabrowski, Andrzej

    2011-01-01

    BACKGROUND: The increasing incidence of obesity and overweight among children and adolescents will be reflected by the imminent increase in the number of obese patients who require more definitive methods of treatment. There is great interest in new, safe, simple, nonsurgical procedures for weight loss. OBJECTIVE: To provide an overview of new endoscopic methods for the treatment of obesity. METHODS: An English-language literature search on endoscopic interventions, endoscopically placed devices and patient safety was performed in the MEDLINE and Cochrane Library databases. RESULTS: The literature search yielded the following weight loss methods: space-occupying devices (widely used), gastric capacity reduction, modifying gastric motor function and malabsorptive procedures. A commercially available intragastric balloon was the most commonly used device for weight loss. In specific subgroups of patients, it improved quality of life, decreased comorbidities and served as a bridge to surgery. More evidence regarding the potential benefits and safety of other commercially available intragastric balloons is needed to clarify whether they are superior to the most commonly used one. Moreover, early experiences with transoral gastroplasty, the duodenaljejunal bypass sleeve and an adjustable, totally implantable intragastric prosthesis, indicate that they may be viable options for obesity treatment. Other agents, such as botulinum toxin and a device known as the ‘butterfly’, are currently at the experimental stage. CONCLUSION: New endoscopic methods for weight loss may be valuable in the treatment of obesity; however, more clinical experience and technical improvements are necessary before implementing their widespread use. PMID:22059171

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

  3. Using Kinesthetic Activities to Teach Ptolemaic and Copernican Retrograde Motion

    ERIC Educational Resources Information Center

    Richards, Ted

    2012-01-01

    This paper describes a method for teaching planetary retrograde motion, and the Ptolemaic and Copernican accounts of retrograde motion, by means of a series kinesthetic learning activities (KLAs). In the KLAs described, the students literally walk through the motions of the planets in both systems. A retrospective statistical analysis shows that…

  4. Biliary leakage after urgent cholecystectomy: Optimization of endoscopic treatment

    PubMed Central

    Ljubičić, Neven; Bišćanin, Alen; Pavić, Tajana; Nikolić, Marko; Budimir, Ivan; Mijić, August; Đuzel, Ana

    2015-01-01

    AIM: To investigate the results of endoscopic treatment of postoperative biliary leakage occurring after urgent cholecystectomy with a long-term follow-up. METHODS: This is an observational database study conducted in a tertiary care center. All consecutive patients who underwent endoscopic retrograde cholangiography (ERC) for presumed postoperative biliary leakage after urgent cholecystectomy in the period between April 2008 and April 2013 were considered for this study. Patients with bile duct transection and biliary strictures were excluded. Biliary leakage was suspected in the case of bile appearance from either percutaneous drainage of abdominal collection or abdominal drain placed at the time of cholecystectomy. Procedural and main clinical characteristics of all consecutive patients with postoperative biliary leakage after urgent cholecystectomy, such as indication for cholecystectomy, etiology and type of leakage, ERC findings and post-ERC complications, were collected from our electronic database. All patients in whom the leakage was successfully treated endoscopically were followed-up after they were discharged from the hospital and the main clinical characteristics, laboratory data and common bile duct diameter were electronically recorded. RESULTS: During a five-year period, biliary leakage was recognized in 2.2% of patients who underwent urgent cholecystectomy. The median time from cholecystectomy to ERC was 6 d (interquartile range, 4-11 d). Endoscopic interventions to manage biliary leakage included biliary stent insertion with or without biliary sphincterotomy. In 23 (77%) patients after first endoscopic treatment bile flow through existing surgical drain ceased within 11 d following biliary therapeutic endoscopy (median, 4 d; interquartile range, 2-8 d). In those patients repeat ERC was not performed and the biliary stent was removed on gastroscopy. In seven (23%) patients repeat ERC was done within one to fourth week after their first ERC

  5. Automated endoscope reprocessors.

    PubMed

    Desilets, David; Kaul, Vivek; Tierney, William M; Banerjee, Subhas; Diehl, David L; Farraye, Francis A; Kethu, Sripathi R; Kwon, Richard S; Mamula, Petar; Pedrosa, Marcos C; Rodriguez, Sarah A; Wong Kee Song, Louis-Michel

    2010-10-01

    The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through February 2010 for articles related to automated endoscope reprocessors, using the words endoscope reprocessing, endoscope cleaning, automated endoscope reprocessors, and high-level disinfection. Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment. PMID:20883843

  6. Single Balloon Enteroscopy for Endoscopic Retrograde Cholangiography in a Patient with Hepaticojejunostomy after Liver Transplant

    PubMed Central

    Di Pisa, Marta; Miraglia, Roberto; Volpes, Riccardo; Gruttadauria, Salvatore; Traina, Mario

    2010-01-01

    We report a case of a post-transplant patient with hepaticojejunostomy in whom we used a single balloon enteroscopy to access the biliary tree. This procedure seems to be safe and feasible for approaching the biliary anastomosis by means of the overtube and fixation of the small bowel by the balloon. PMID:20454574

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

    PubMed Central

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

    2015-01-01

    Increased incidence of infections due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) was noted among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at a single hospital. An epidemiologic investigation identified KPC-Kp and non-KPC-producing, extended-spectrum β-lactamase (ESBL)-producing Kp in cultures from 2 endoscopes. Genotyping was performed on patient and endoscope isolates to characterize the microbial genomics of the outbreak. Genetic similarity of 51 Kp isolates from 37 patients and 3 endoscopes was assessed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Five patient and 2 endoscope isolates underwent whole genome sequencing (WGS). Two KPC-encoding plasmids were characterized by single molecule, real-time sequencing. Plasmid diversity was assessed by endonuclease digestion. Genomic and epidemiologic data were used in conjunction to investigate the outbreak source. Two clusters of Kp patient isolates were genetically related to endoscope isolates by PFGE. A subset of patient isolates were collected post-ERCP, suggesting ERCP endoscopes as a possible source. A phylogeny of 7 Kp genomes from patient and endoscope isolates supported ERCP as a potential source of transmission. Differences in gene content defined 5 ST258 subclades and identified 2 of the subclades as outbreak-associated. A novel KPC-encoding plasmid, pKp28 helped define and track one endoscope-associated ST258 subclade. WGS demonstrated high genetic relatedness of patient and ERCP endoscope isolates suggesting ERCP-associated transmission of ST258 KPC-Kp. Gene and plasmid content discriminated the outbreak from endemic ST258 populations and assisted with the molecular epidemiologic investigation of an extended KPC-Kp outbreak. PMID:26637170

  8. Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

    PubMed

    Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

    2016-01-01

    Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones. PMID:27047698

  9. Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

    PubMed Central

    Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

    2016-01-01

    Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones. PMID:27047698

  10. Distant retrograde orbits for the Moon's exploration

    NASA Astrophysics Data System (ADS)

    Sidorenko, Vladislav

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

  11. Asteroids in Retrograde Orbits: Interesting Cases

    NASA Astrophysics Data System (ADS)

    Kankiewicz, Paweł; Włodarczyk, Ireneusz

    2014-12-01

    We present the most interesting examples of the orbital evolution of asteroids in retrograde orbits (i > 90°). First, we used the latest observational data to determine nominal and averaged orbital elements of these objects. Next, the equations of motion of these asteroids were integrated backward 1 My, taking into account the propagation of observational errors. We used so-called 'cloning' procedure to reproduce the reliability of initial data. We obtained some possible scenarios of the orbit inversion in the past, what is often caused by the long-term influence of outer planets. For two most interesting cases (Apollo and Amor type) we did additional calculations: 100 My in the future. Additionally, we investigated the potential influence of Yarkovski/YORP effects on the long-time orbital evolution.

  12. Retrograde Epidural Catheter Relieves Intractable Sacral Pain.

    PubMed

    Gupta, Ruchir; Shodhan, Shivam; Hosny, Amr

    2016-01-01

    Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a "band of anesthesia" which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique. PMID:27162431

  13. Retrograde Epidural Catheter Relieves Intractable Sacral Pain

    PubMed Central

    Gupta, Ruchir; Shodhan, Shivam; Hosny, Amr

    2016-01-01

    Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made to insert an epidural catheter via a retrograde technique to provide the patient with a “band of anesthesia” which would provide profound sensory blockade without concomitant motor weakness. Pain refractory to other modalities of pain control was successfully treated with the epidural technique. PMID:27162431

  14. [Endoscopic Therapy for Esophageal Cancer].

    PubMed

    Sakai, Makoto; Kuwano, Hiroyuki

    2016-07-01

    Endoscopic treatment for esophageal neoplasms includes endoscopic resection, argon plasma coagulation(APC), photodynamic therapy( PDT) and stent placement. Endoscopic resection is widely used as an effective, less invasive treatment for superficial esophageal carcinoma in Japan. APC is considered to be safe and effective treatment for superficial esophageal carcinoma which cannot be resected endoscopically because of severe comorbidities, as well as for local recurrence after endoscopic resection or chemoradiotherapy. PDT is thought to be an effective option as salvage treatment for local failure after chemoradiotherapy. Stent placement mainly using self-expanding metallic stents have been used as a minimally invasive and effective modality for the palliative treatment of malignant esophageal obstruction. Endoscopic treatment is expected to have more important role in the treatment of esophageal neoplasms in the future. PMID:27440040

  15. Biomechanical performance of retrograde nail for supracondylar fractures stabilization.

    PubMed

    Chantarapanich, Nattapon; Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Siribodhi, Pongwit

    2016-06-01

    The study compared the biomechanical performance of retrograde nail used to stabilize supracondylar fracture (three different levels) by means of finite element analysis. Three different nail lengths (200, 260, and 300 mm) of stainless steel and titanium nails were under consideration. Intact femur model was reconstructed from Digital Imaging and Communications in Medicine images of Thai cadaveric femur scanned by computed tomography spiral scanner, whereas geometry of retrograde nail was reconstructed with the data obtained from three-dimensional laser scanner. The retrograde nail was virtually attached to the femur before nodes and elements were generated for finite element model. The finite element models were analyzed in two stages, the early stage of fracture healing and the stage after fracture healing. The finding indicated that purchasing proximal locking screw in the bowing region of the femur may be at risk due to the high stresses at the implant and bone. There were no differences in stress level, elastic strain at a fracture gap, and bone stress between stainless steel and titanium implant. Since the intramedullary canal requires reaming to accommodate the retrograde nail, the length of retrograde nail should be as long as necessary. However, in case that the retrograde nail can be accommodated into the intramedullary canal without reaming, the longer retrograde nail can be used. PMID:27032932

  16. PRODUCTION OF NEAR-EARTH ASTEROIDS ON RETROGRADE ORBITS

    SciTech Connect

    Greenstreet, S.; Gladman, B.; Ngo, H.; Granvik, M.; Larson, S.

    2012-04-20

    While computing an improved near-Earth object (NEO) steady-state orbital distribution model, we discovered in the numerical integrations the unexpected production of retrograde orbits for asteroids that had originally exited from the accepted main-belt source regions. Our model indicates that {approx}0.1% (a factor of two uncertainty) of the steady-state NEO population (perihelion q < 1.3 AU) is on retrograde orbits. These rare outcomes typically happen when asteroid orbits flip to a retrograde configuration while in the 3:1 mean-motion resonance with Jupiter and then live for {approx}0.001 to 100 Myr. The model predicts, given the estimated near-Earth asteroid (NEA) population, that a few retrograde 0.1-1 km NEAs should exist. Currently, there are two known MPC NEOs with asteroidal designations on retrograde orbits which we therefore claim could be escaped asteroids instead of devolatilized comets. This retrograde NEA population may also answer a long-standing question in the meteoritical literature regarding the origin of high-strength, high-velocity meteoroids on retrograde orbits.

  17. Endoscopic Gastrointestinal Laser Therapy

    PubMed Central

    Buchi, Kenneth N.

    1985-01-01

    The development of flexible fibers for the delivery of laser energy led to the first endoscopic laser applications in humans in the early 1970s. Since that time, much has been learned about applications throughout the gastrointestinal tract. The risks appear to be minimal. The coagulative effect of laser energy is used to treat gastrointestinal hemorrhage and small, benign mucosal lesions. The ablative effect of the Nd:YAG laser on tissue is used for palliative therapy for malignant gastrointestinal disorders and incisional therapy for anatomic lesions such as strictures or cysts. New laser modalities that potentially can be tuned throughout large segments of the electromagnetic spectrum, new fiber-optic delivery systems with specialized tips and new methods of sensitizing tissue to laser energy all indicate that the endoscopic laser should continue to have many new and innovative applications. ImagesFigure 1.Figure 2.Figure 3. PMID:3911589

  18. From Capsule Endoscopy to Balloon-Assisted Deep Enteroscopy: Exploring Small-Bowel Endoscopic Imaging.

    PubMed

    Cooley, D Matthew; Walker, Andrew J; Gopal, Deepak V

    2015-03-01

    In the past 15 years, the use of endoscopic evaluations in patients with obscure gastrointestinal bleeding has become more common. Indications for further endoscopic interventions include iron deficiency anemia, suspicion of Crohn's disease or small-bowel tumors, assessment of celiac disease or of ulcers induced by nonsteroidal anti-inflammatory drugs, and screening for familial adenomatous polyposis. Often, capsule endoscopy is performed in concert with other endoscopic studies and can guide decisions regarding whether enteroscopy should be carried out in an anterograde or a retrograde approach. Retrograde endoscopy is beneficial in dealing with disease of the more distal small bowel. Multiple studies have examined the diagnostic yield of balloon-assisted deep enteroscopy and have estimated a diagnostic yield of 40% to 80%. Some of the studies have found that diagnostic yields are higher when capsule endoscopy is performed before balloon-assisted deep enteroscopy in a search for small-bowel bleeds. Each of these procedures has a role when performed alone; however, research suggests that they are especially effective as complementary techniques and together can provide better-directed therapy. Both procedures are relatively safe, with high diagnostic and therapeutic yields that allow evaluation of the small bowel. Because both interventions are relatively new to the world of gastroenterology, much research remains to be done regarding their overall efficacy, cost, and safety, as well as further indications for their use in the detection and treatment of diseases of the small bowel. PMID:27099585

  19. From Capsule Endoscopy to Balloon-Assisted Deep Enteroscopy: Exploring Small-Bowel Endoscopic Imaging

    PubMed Central

    Cooley, D. Matthew; Walker, Andrew J.

    2015-01-01

    In the past 15 years, the use of endoscopic evaluations in patients with obscure gastrointestinal bleeding has become more common. Indications for further endoscopic interventions include iron deficiency anemia, suspicion of Crohn’s disease or small-bowel tumors, assessment of celiac disease or of ulcers induced by nonsteroidal anti-inflammatory drugs, and screening for familial adenomatous polyposis. Often, capsule endoscopy is performed in concert with other endoscopic studies and can guide decisions regarding whether enteroscopy should be carried out in an anterograde or a retrograde approach. Retrograde endoscopy is beneficial in dealing with disease of the more distal small bowel. Multiple studies have examined the diagnostic yield of balloon-assisted deep enteroscopy and have estimated a diagnostic yield of 40% to 80%. Some of the studies have found that diagnostic yields are higher when capsule endoscopy is performed before balloon-assisted deep enteroscopy in a search for small-bowel bleeds. Each of these procedures has a role when performed alone; however, research suggests that they are especially effective as complementary techniques and together can provide better-directed therapy. Both procedures are relatively safe, with high diagnostic and therapeutic yields that allow evaluation of the small bowel. Because both interventions are relatively new to the world of gastroenterology, much research remains to be done regarding their overall efficacy, cost, and safety, as well as further indications for their use in the detection and treatment of diseases of the small bowel. PMID:27099585

  20. Endoscopic and Microscopic Microvascular Decompression.

    PubMed

    Piazza, Matthew; Lee, John Y K

    2016-07-01

    The introduction of the endoscope into the neurosurgeon's armamentarium has revolutionized ventral and anterior skull-base surgery and, more recently, has been used in the surgical treatment of cerebellopontine angle (CPA) pathology. The utilization of the endoscope in microvascular decompression (MVD) for trigeminal neuralgia and other associated cranial nerve hyperactivity syndromes allows for unparalleled panoramic views and illumination of the neurovascular structures within the CPA and identification of vessel-nerve contact traditionally unseen using the microscope. In this article, the technical advantages and challenges of using the endoscope for MVD, operative technique, and patient outcomes of endoscopic MVD are discussed. PMID:27324997

  1. Fluorescence endoscopic video system

    NASA Astrophysics Data System (ADS)

    Papayan, G. V.; Kang, Uk

    2006-10-01

    This paper describes a fluorescence endoscopic video system intended for the diagnosis of diseases of the internal organs. The system operates on the basis of two-channel recording of the video fluxes from a fluorescence channel and a reflected-light channel by means of a high-sensitivity monochrome television camera and a color camera, respectively. Examples are given of the application of the device in gastroenterology.

  2. [Endoscopic interventions in pulmonology].

    PubMed

    Gompelmann, D; Herth, F J F

    2016-08-01

    Bronchoscopy plays a significant role in the diagnosis and treatment of pulmonary diseases. Hemoptysis, or central airway obstruction, is a common indication for interventional bronchoscopy. In addition, the treatment of early lung cancer is the domain of bronchoscopy in inoperable patients. In recent years, endoscopic techniques have also been established as new therapeutic options in advanced chronic obstructive pulmonary disease and uncontrolled bronchial asthma. PMID:27351790

  3. Peroral endoscopic myotomy.

    PubMed

    Kumbhari, Vivek; Khashab, Mouen A

    2015-05-16

    Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited. PMID:25992188

  4. Peroral endoscopic myotomy

    PubMed Central

    Kumbhari, Vivek; Khashab, Mouen A

    2015-01-01

    Peroral endoscopic myotomy (POEM) incorporates concepts of natural orifice translumenal endoscopic surgery and achieves endoscopic myotomy by utilizing a submucosal tunnel as an operating space. Although intended for the palliation of symptoms of achalasia, there is mounting data to suggest it is also efficacious in the management of spastic esophageal disorders. The technique requires an understanding of the pathophysiology of esophageal motility disorders as well as knowledge of surgical anatomy of the foregut. POEM achieves short term response in 82% to 100% of patients with minimal risk of adverse events. In addition, it appears to be effective and safe even at the extremes of age and regardless of prior therapy undertaken. Although infrequent, the ability of the endoscopist to manage an intraprocedural adverse event is critical as failure to do so could result in significant morbidity. The major late adverse event is gastroesophageal reflux which appears to occur in 20% to 46% of patients. Research is being conducted to clarify the optimal technique for POEM and a personalized approach by measuring intraprocedural esophagogastric junction distensibility appears promising. In addition to esophageal disorders, POEM is being studied in the management of gastroparesis (gastric pyloromyotomy) with initial reports demonstrating technical feasibility. Although POEM represents a paradigm shift the management of esophageal motility disorders, the results of prospective randomized controlled trials with long-term follow up are eagerly awaited. PMID:25992188

  5. New Endoscopic Hemostasis Methods

    PubMed Central

    Leung Ki, En-Ling

    2012-01-01

    Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension. PMID:22977807

  6. New endoscopic hemostasis methods.

    PubMed

    Leung Ki, En-Ling; Lau, James Y W

    2012-09-01

    Endoscopic treatment for non-variceal upper gastrointestinal bleeding has evolved over decades. Injection with diluted epinephrine is considered as a less than adequate treatment, and the current standard therapy should include second modality if epinephrine injection is used initially. Definitive hemostasis rate following mono-therapy with either thermo-coagulation or hemo-clipping compares favorably with dual therapies. The use of adsorptive powder (Hemo-spray) is a promising treatment although it needs comparative studies between hemospray and other modalities. Stronger hemo-clips with better torque control and wider span are now available. Over-the-scope clips capture a large amount of tissue and may prove useful in refractory bleeding. Experimental treatments include an endoscopic stitch device to over-sew the bleeding lesion and targeted therapy to the sub-serosal bleeding artery as guided by echo-endoscopy. Angiographic embolization of bleeding artery should be considered in chronic ulcers that fail endoscopic treatment especially in elderly patients with a major bleed manifested in hypotension. PMID:22977807

  7. Using Kinesthetic Activities to Teach Ptolemaic and Copernican Retrograde Motion

    NASA Astrophysics Data System (ADS)

    Richards, Ted

    2012-06-01

    This paper describes a method for teaching planetary retrograde motion, and the Ptolemaic and Copernican accounts of retrograde motion, by means of a series kinesthetic learning activities (KLAs). In the KLAs described, the students literally walk through the motions of the planets in both systems. A retrospective statistical analysis shows that students who participated in these activities performed better on examination questions pertaining to retrograde motion than students who did not. Potential explanations for this result, including the breaking of classroom routine, the effect of body movement on conceptual memory, and egocentric spatial proprioception, are considered.

  8. Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent.

    PubMed

    Chang, Arunchai; Aswakul, Pitulak; Prachayakul, Varayu

    2016-04-16

    One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis. PMID:27099862

  9. Chronic pancreatic pain successfully treated by endoscopic ultrasound-guided pancreaticogastrostomy using fully covered self-expandable metallic stent

    PubMed Central

    Chang, Arunchai; Aswakul, Pitulak; Prachayakul, Varayu

    2016-01-01

    One of the most common symptoms presenting in patients with chronic pancreatitis is pancreatic-type pain. Obstruction of the main pancreatic duct in chronic pancreatitis can be treated by a multitude of therapeutic approaches, ranging from pharmacologic, endoscopic and radiologic treatments to surgical interventions. When the conservative treatment approaches fail to resolve symptomatic cases, however, endoscopic retrograde pancreatography with pancreatic duct drainage is the preferred second approach, despite its well-recognized drawbacks. When the conventional transpapillary approach fails to achieve the necessary drainage, the patients may benefit from application of the less invasive endoscopic ultrasound (EUS)-guided pancreatic duct interventions. Here, we describe the case of a 42-year-old man who presented with severe abdominal pain that had lasted for 3 mo. Computed tomography scanning showed evidence of chronic obstructive pancreatitis with pancreatic duct stricture at genu. After conventional endoscopic retrograde pancreaticography failed to eliminate the symptoms, EUS-guided pancreaticogastrostomy (PGS) was applied using a fully covered, self-expandable, 10-mm diameter metallic stent. The treatment resolved the case and the patient experienced no adverse events. EUS-guided PGS with a regular biliary fully covered, self-expandable metallic stent effectively and safely treated pancreatic-type pain in chronic pancreatitis. PMID:27099862

  10. Percutaneous endoscopic cervical discectomy using working channel endoscopes.

    PubMed

    Ahn, Yong

    2016-06-01

    Percutaneous endoscopic cervical discectomy has evolved as an efficient, minimally invasive spine surgery for cervical disc herniation or radiculopathy. The development of the working channel endoscope makes definitive decompression surgery through a percutaneous approach feasible. There are two methods of approach to target the pathology: anterior and posterior approach. The approach can be determined according to the zone of pathology or the surgeon's preference. The most significant benefits of this endoscopic surgical technique are minimal access tissue trauma and early recovery from the intervention. However, this technique is still evolving and have a steep learning curve. Extensive development of surgical technique and working channel endoscopes will enable us to treat cervical disc herniation more practically. The objective of this review is to describe the cutting-edge techniques of endoscopic surgery in the cervical spine and to discuss the pros and cons of these minimally invasive surgical techniques. PMID:27086505

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

    PubMed Central

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

    2014-01-01

    Early detection of early gastric cancer (EGC) is important to improve the prognosis of patients with gastric cancer. Recent advances in endoscopic modalities and treatment devices, such as image-enhanced endoscopy and high-frequency generators, may make endoscopic treatment, such as endoscopic submucosal dissection, a therapeutic option for gastric intraepithelial neoplasia. Consequently, short-term outcomes of endoscopic resection (ER) for EGC have improved. Therefore, surveillance with endoscopy after ER for EGC is becoming more important, but how to perform endoscopic surveillance after ER has not been established, even though the follow-up strategy for more advanced gastric cancer has been outlined. Therefore, a surveillance strategy for patients with EGC after ER is needed. PMID:24891981

  12. Retrograde crossing for chronic total occlusion lesions: the Japanese way.

    PubMed

    Takano, Masamichi; Mizuno, Kyoichi

    2008-01-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions remains one of the major challenges in the field of interventional cardiology. Crossing guidewires through the CTO lesions has been conventionally performed from the proximal arteries to the lesions as an antegrade approach. To date, a retrograde approach, to penetrate PCI devices including guidewires and balloons into the distal end of CTO lesions via collateral vessels or coronary artery bypass grafts, has been attempted in order to achieve procedural success. With introduction of the retrograde approach for treatments of CTO lesions, several kinds of devices, techniques, and strategies have been developed. Although the techniques and strategies for the retrograde approach have not been worldwide accepted to interventional cardiologists, we introduce a way to obtain recanalization of the CTO lesions using the retrograde approach in this article. PMID:19276488

  13. The 'SAFARI' Technique Using Retrograde Access Via Peroneal Artery Access

    SciTech Connect

    Zhuang, Kun Da; Tan, Seck Guan; Tay, Kiang Hiong

    2012-08-15

    The 'SAFARI' technique or subintimal arterial flossing with antegrade-retrograde intervention is a method for recanalisation of chronic total occlusions (CTOs) when subintimal angioplasty fails. Retrograde access is usually obtained via the popliteal, distal anterior tibial artery (ATA)/dorsalis pedis (DP), or distal posterior tibial artery (PTA). Distal access via the peroneal artery has not been described and has a risk of continued bleeding, leading to compartment syndrome due to its deep location. We describe our experience in two patients with retrograde access via the peroneal artery and the use of balloon-assisted hemostasis for these retrograde punctures. This approach may potentially give more options for endovascular interventions in lower limb CTOs.

  14. Fundamental studies of retrograde reactions in direct liquefaction

    SciTech Connect

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

    1989-01-01

    Most of the proposed processing schemes for improving liquefaction yields involve favoring bond-breaking and radical stabilization reactions over the retrograde reactions. The retrograde reactions are often encountered before liquefaction temperatures are reached. The objective of this program is to elucidate and model the retrograde reaction chemistry in direct coal liquefaction through the application of experimental techniques and theoretical models which have been successfully employed at Advanced Fuel Research (AFR) and SRI International (a subcontractor) to understand and predict coal reaction behavior. The study of retrograde reactions is being done using an integrated approach using extensive characterization of the liquefaction chemistry of three kinds of systems: (1) model polymers; (2) coal; and (3) modified coals.

  15. Endoscopic Hands-Off Technique versus Conventional Technique for Conversion from an Orobiliary to a Nasobiliary Tube

    PubMed Central

    Lee, Miyeon; Kim, Soon Sun; Yoo, Byung Moo; Kim, Jin Hong

    2016-01-01

    Background. The aim of this study was to compare the outcomes of the endoscopic hands-off technique and the conventional technique when repositioning an endoscopic nasobiliary drainage (ENBD) tube from the mouth to the nose. Methods. We conducted a retrospective cohort study of all endoscopic retrograde cholangiopancreatographies (ERCPs) performed between July 2013 and May 2015 at a single tertiary referral center. A total of 1187 ERCPs were performed during the study period. Among them, 114 patients who underwent ENBD were enrolled in this study. In those patients, we used the endoscopic hands-off technique between July 2013 and May 2014 (endoscopy group) and the conventional technique between June 2014 and May 2015 (conventional group). Results. Technical success was achieved in 100% (58/58) of the endoscopy group and 94.6% (53/56) of the conventional group (P = 0.115). In the 3 cases of failed conventional technique, the endoscopic hands-off technique was then performed, and conversion of the ENBD tube was successful in all of these patients. The procedure time was significantly shorter in the endoscopy group than in the conventional group (124 s versus 149 s, P = 0.001). Conclusion. The endoscopic hands-off technique was feasible and effective for oral-nasal conversion of an ENBD tube. PMID:27462348

  16. Rinsability of orthophthalaldehyde from endoscopes.

    PubMed

    Miner, Norman; Harris, Valerie; Lukomski, Natalie; Ebron, Towanda

    2012-01-01

    Orthophthalaldehyde high level disinfectants are contraindicated for use with urological instruments such as cystoscopes due to anaphylaxis-like allergic reactions during surveillance of bladder cancer patients. Allergic reactions and mucosal injuries have also been reported following colonoscopy, laryngoscopy, and transesophageal echocardiography with devices disinfected using orthophthalaldehyde. Possibly these endoscopes were not adequately rinsed after disinfection by orthophthalaldehyde. We examined this possibility by means of a zone-of-inhibition test, and also a test to extract residues of orthophthalaldehyde with acetonitrile, from sections of endoscope insertion tube materials, to measure the presence of alkaline glutaraldehyde, or glutaraldehyde plus 20% w/w isopropanol, or ortho-phthalaldehyde that remained on the endoscope materials after exposure to these disinfectants followed by a series of rinses in water, or by aeration overnight. Zones of any size indicated the disinfectant had not been rinsed away from the endoscope material. There were no zones of inhibition surrounding endoscope materials soaked in glutaraldehyde or glutaraldehyde plus isopropanol after three serial water rinses according to manufacturers' rinsing directions. The endoscope material soaked in orthophthalaldehyde produced zones of inhibition even after fifteen serial rinses with water. Orthophthalaldehyde was extracted from the rinsed endoscope material by acetonitrile. These data, and other information, indicate that the high level disinfectant orthophthalaldehyde, also known as 1,2-benzene dialdehyde, cannot be rinsed away from flexible endoscope material with any practical number of rinses with water, or by drying overnight. PMID:22665966

  17. Endoscopic Gastrocnemius Intramuscular Aponeurotic Recession

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Gastrocnemius aponeurotic recession is the surgical treatment for symptomatic gastrocnemius contracture. Endoscopic gastrocnemius recession procedures has been developed recently and reported to have fewer complications and better cosmetic outcomes. Classically, this is performed at the aponeurosis distal to the gastrocnemius muscle attachment. We describe an alternative endoscopic approach in which the intramuscular portion of the aponeurosis is released. PMID:26900563

  18. Retrograde Melting and Internal Liquid Gettering in Silicon

    SciTech Connect

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

    2011-07-01

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

  19. Retrograde intrarenal surgery in cross-fused ectopic kidney.

    PubMed

    Resorlu, Mustafa; Kabar, Mucahit; Resorlu, Berkan; Doluoglu, Omer Gokhan; Kilinc, Muhammet Fatih; Karakan, Tolga

    2015-02-01

    Cross-fused renal ectopia is a rare congenital anomaly in which both kidneys are fused and located on the same side. We report a case of right-to-left cross-fused renal ectopia and nephrolithiasis, in whom retrograde intrarenal surgery was used to treat the stone disease. To our knowledge, this is the first case of retrograde intrarenal surgery of a crossed-fused ectopic kidney. PMID:25481231

  20. [Endoscopic vacuum-assisted closure].

    PubMed

    Wedemeyer, J; Lankisch, T

    2013-03-01

    Anastomotic leakage in the upper and lower intestinal tract is associated with high morbidity and mortality. Within the last 10 years endoscopic treatment options have been accepted as sufficient treatment option of these surgical complications. Endoscopic vacuum assisted closure (E-VAC) is a new innovative endoscopic therapeutic option in this field. E-VAC transfers the positive effects of vacuum assisted closure (VAC) on infected cutaneous wounds to infected cavities that can only be reached endoscopically. A sponge connected to a drainage tube is endoscopically placed in the leakage and a continuous vacuum is applied. Sponge and vacuum allow removal of infected fluids and promote granulation of the leakage. This results in clean wound grounds and finally allows wound closure. Meanwhile the method was also successfully used in the treatment of necrotic pancreatitis. PMID:23430199

  1. Endoscopic ultrasound in mediastinal tuberculosis

    PubMed Central

    Sharma, Malay; Ecka, Ruth Shifa; Somasundaram, Aravindh; Shoukat, Abid; Kirnake, Vijendra

    2016-01-01

    Background: Tubercular lymphadenitis is the commonest extra pulmonary manifestation in cervical and mediastinal locations. Normal characteristics of lymph nodes (LN) have been described on ultrasonography as well as by Endoscopic Ultrasound. Many ultrasonic features have been described for evaluation of mediastinal lymph nodes. The inter and intraobserver agreement of the endosonographic features have not been uniformly established. Methods and Results: A total of 266 patients underwent endoscopic ultrasound guided fine needle aspiration and 134 cases were diagnosed as mediastinal tuberculosis. The endoscopic ultrasound location and features of these lymph nodes are described. Conclusion: Our series demonstrates the utility of endoscopic ultrasound guided fine needle aspiration as the investigation of choice for diagnosis of mediastinal tuberculosis and also describes various endoscopic ultrasound features of such nodes. PMID:27051097

  2. Endoscopic resection of subepithelial tumors

    PubMed Central

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

    2014-01-01

    Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection of SET arising from deeper layers of the gastrointestinal wall requires advanced endoscopic methods and harbours the risk of perforation. Innovative techniques such as submucosal tunneling and full thickness resection have expanded the frontiers of endoscopic therapy in the past years. This review will give an overview about endoscopic resection techniques of SET with a focus on novel methods. PMID:25512768

  3. Endoscopic treatment of oesophageal varices.

    PubMed

    Krige, J E; Bornman, P C

    2000-12-01

    Major variceal bleeding is a life-threatening complication of portal hypertension. Therapy for bleeding may be difficult and requires expertise and appropriate facilities. Endoscopic therapy using either injection sclerotherapy or band ligation after adequate resuscitation and diagnostic endoscopy is the preferred first-line treatment. Bleeding not controlled by initial endoscopic therapy requires balloon tamponade followed by repeat variceal ligation or sclerotherapy. Patients who continue to bleed after endoscopic therapy are best treated with percutaneous radiological transjugular intrahepatic portosystemic shunt stent (TIPSS) insertion. After variceal eradication, patients require lifelong surveillance endoscopy and re-obliteration of varices by endoscopic therapy if they recur. Beta-blockers to prevent recurrent bleeding are reserved for selected patients. Patients with severe liver decompensation have a poor prognosis and should be evaluated for liver transplantation. Prophylactic endoscopic therapy in patients who have never bled from varices is contraindicated as it is associated with increased morbidity and mortality. PMID:11424860

  4. Endoscopic Therapy in Chronic Pancreatitis

    PubMed Central

    Tan, Damien Meng Yew

    2011-01-01

    Chronic pancreatitis (CP) is a debilitating disease that can result in chronic abdominal pain, malnutrition, and other related complications. The main aims of treatment are to control symptoms, prevent disease progression, and correct any complications. A multidisciplinary approach involving medical, endoscopic, and surgical therapy is important. Endoscopic therapy plays a specific role in carefully selected patients as primary interventional therapy when medical measures fail or in patients who are not suitable for surgery. Endoscopic therapy is also used as a bridge to surgery or as a means to assess the potential response to pancreatic surgery. This review addresses the role of endoscopic therapy in relief of obstruction of the pancreatic duct (PD) and bile du ct, closure of PD leaks, and drainage of pseudocysts in CP. The role of endoscopic ultrasound-guided celiac plexus block for pain in chronic pancreatitis is also discussed. PMID:22205838

  5. Endoscopic laser-urethroplasty

    NASA Astrophysics Data System (ADS)

    Gilbert, Peter

    2006-02-01

    The objective was to prove the advantage of endoscopic laser-urethroplasty over internal urethrotomy in acquired urethral strictures. Patients and Method: From January, 1996 to June, 2005, 35 patients with a mean age of 66 years were submitted to endoscopic laser-urethroplasty for strictures of either the bulbar (30) or membranous (5) urethra. The operations were carried out under general anesthesia. First of all, the strictures were incised at the 4, 8 and 12 o'clock position by means of a Sachse-urethrotom. Then the scar flap between the 4 and 8 o'clock position was vaporized using a Nd:YAG laser, wavelength 1060 nm and a 600 pm bare fiber, the latter always being in contact with the tissue. The laser worked at 40W power in continuous mode. The total energy averaged 2574 J. An indwelling catheter was kept in place overnight and the patients were discharged the following day. Urinalysis, uroflowmetry and clinical examination were performed at two months after surgery and from then on every six months. Results: No serious complications were encountered. Considering a mean follow-up of 18 months, the average peak flow improved from 7.3 ml/s preoperatively to 18.7 mVs postoperatively. The treatment faded in 5 patients ( 14.3% ) who finally underwent open urethroplasty. Conclusions: Endoscopic laser-urethroplasty yields better short-term results than internal visual urethrotomy. Long-term follow-up has yet to confirm its superiority in the treatment of acquired urethral strictures.

  6. Endoscopic Endonasal Transsphenoidal Approach

    PubMed Central

    Cappabianca, Paolo; Alfieri, Alessandra; Colao, Annamaria; Ferone, Diego; Lombardi, Gaetano; de Divitiis, Enrico

    1999-01-01

    The outcome of endoscopic endonasal transsphenoidal surgery in 10 patients with pituitary adenomas was compared with that of traditional transnasal transsphenoidal approach (TTA) in 20 subjects. Among the 10 individuals subjected to “pure endoscopy,” 2 had a microadenoma, 1 an intrasellar macroadenoma, 4 had a macroadenoma with suprasellar expansion, 2 had a macroadenoma with supra-parasellar expansion, and 1 a residual tumor; 5 had acromegaly and 5 had a nonfunctioning adenoma (NFA). Among the patients subjected to TTA, 4 had a microadenoma, 2 had an intrasellar macroadenoma, 6 had a macroadenoma with suprasellar expansion, 4 had a macroadenoma with supra-parasellar expansion, and 4 had a residual tumor; 9 patients had acromegaly, 1 hyperprolactinemia, 1 Cushing's disease, and 9 a NFA. At the macroscopic evaluation, tumor removal was total (100%) after endoscopy in 9 patients and after TTA in 14 patients. Six months after surgery, magnetic resonance imaging (MRI) confirmed the total tumor removal in 21 of 23 patients (91.3%). Circulating growth hormone (GH) and insulin-like growth factor-I (IGF-I) significantly decreased 6 months after surgery in all 14 acromegalic patients: normalization of plasma IGF-I levels was obtained in 4 of 5 patients after the endoscopic procedure and in 4 of 9 patients after TTA. Before surgery, pituitary hormone deficiency was present in 14 out of 30 patients: pituitary function improved in 4 patients, remaining unchanged in the other 10 patients. Visual field defects were present before surgery in 4 patients, and improved in all. Early surgical results in the group of 10 patients who underwent endoscopic pituitary tumor removal were at least equivalent to those of standard TTA, with excellent postoperative course. Postsurgical hospital stay was significantly shorter (3.1 ± 0.4 vs. 6.2 ± 0.3 days, p < 0.001) after endoscopy as compared to TTA. ImagesFigure 1Figure 2 PMID:17171126

  7. Endoscopic pituitary surgery.

    PubMed

    Cappabianca, Paolo; Cavallo, Luigi Maria; de Divitiis, Oreste; Solari, Domenico; Esposito, Felice; Colao, Annamaria

    2008-01-01

    Pituitary surgery is a continuous evolving speciality of the neurosurgeons' armamentarium, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pituitary pathophysiology. What we consider "pure" endoscopic transsphenoidal surgery is a procedure performed through the nose and the sphenoid bone, with the endoscope alone throughout the whole approach to visualize the surgical target area and without the use of any transsphenoidal retractor. It offers some advantages due to the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle are provided with an increased panoramic vision inside the surgical area. Concerning results in terms of mass removal, relief of clinical symptoms, cure of the underlying disease and complication rate, they are, at least, similar to those reported in the major microsurgical series, but patient compliance is by far better. Furthermore transsphenoidal endoscopy brings advantages to the patient (less nasal traumatism, no nasal packing, less post-op pain and usually quick recovery), to the surgeon (wider and closer view of the surgical target area, increase of the scientific activity as from the peer-reviewed literature on the topic in the last 10 years, smoothing of interdisciplinary cooperation), to the institution (shorter post-op hospital stay, increase of the case load). Besides, further progress and technological advance are expected from the close cooperation between different technologies and industries. Continuing works in such field of "minimalism" will offer further possibilities to provide the surgeon with even more effectiveness and safety, and, on the other hand, the patient with improvement of results. PMID:18286374

  8. Endoscopic extraperitoneal lumbar sympathectomy.

    PubMed

    Hourlay, P; Vangertruyden, G; Verduyckt, F; Trimpeneers, F; Hendrickx, J

    1995-05-01

    From June 24, 1993, until November 9, 1993, eight sympathectomies were performed by extraperitoneal endoscopy for treatment of Sudeck atrophy. Seventy-five percent of the patients were satisfied with the result of the intervention. A follow-up after 4 months shows that four patients are free of pain. Two are satisfied, but some pain remains. In two cases, the intensity of the pain remains unchanged but the character of the pain has changed. This new technique is safe and offers the well-known advantages of minimal invasive surgery. Moreover, this endoscopic approach opens perspectives for the exploration of the entire retroperitoneum. PMID:7545831

  9. Endoscopic mucosal resection.

    PubMed

    Hwang, Joo Ha; Konda, Vani; Abu Dayyeh, Barham K; Chauhan, Shailendra S; Enestvedt, Brintha K; Fujii-Lau, Larissa L; Komanduri, Sri; Maple, John T; Murad, Faris M; Pannala, Rahul; Thosani, Nirav C; Banerjee, Subhas

    2015-08-01

    EMR has become an established therapeutic option for premalignant and early-stage GI malignancies, particularly in the esophagus and colon. EMR can also aid in the diagnosis and therapy of subepithelial lesions localized to the muscularis mucosa or submucosa. Several dedicated EMR devices are available to facilitate these procedures. Adverse event rates, particularly bleeding and perforation, are higher after EMR relative to other basic endoscopic interventions but lower than adverse event rates for ESD. Endoscopists performing EMR should be knowledgeable and skilled in managing potential adverse events resulting from EMR. PMID:26077453

  10. Therapeutic Endoscopic Ultrasound

    PubMed Central

    Cheriyan, Danny

    2015-01-01

    Endoscopic ultrasound (EUS) technology has evolved dramatically over the past 20 years, from being a supplementary diagnostic aid available only in large medical centers to being a core diagnostic and therapeutic tool that is widely available. Although formal recommendations and practice guidelines have not been developed, there are considerable data supporting the use of EUS for its technical accuracy in diagnosing pancreaticobiliary and gastrointestinal pathology. Endosonography is now routine practice not only for pathologic diagnosis and tumor staging but also for drainage of cystic lesions and celiac plexus neurolysis. In this article, we cover the use of EUS in biliary and pancreatic intervention, ablative therapy, enterostomy, and vascular intervention. PMID:27118942

  11. Long-term successful treatment of massive distal duodenal variceal bleeding with balloon-occluded retrograde transvenous obliteration.

    PubMed

    Hwang, Soon Woo; Sohn, Joo Hyun; Kim, Tae Yeob; Kim, Ji Yeoun; Yhi, Jiyoung; Kwak, Dong Shin; Kim, Hae Su; Song, Soon-Young

    2014-04-01

    Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location. PMID:24755751

  12. Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Gastric Variceal Hemorrhage

    PubMed Central

    Chang, Min-Yung; Kim, Taehwan; Shin, Wonseon; Shin, Minwoo; Kim, Gyoung Min; Won, Jong Yun; Park, Sung Il; Lee, Do Yun

    2016-01-01

    Objective To evaluate the feasibility, safety, and clinical outcomes of plug-assisted retrograde transvenous obliteration (PARTO) to treat gastric variceal hemorrhage in patients with portal hypertension. Materials and Methods From May 2012 to June 2014, 19 patients (11 men and 8 women, median age; 61, with history of gastric variceal hemorrhage; 17, active bleeding; 2) who underwent PARTO using a vascular plug and a gelfoam pledget were retrospectively analyzed. Clinical and laboratory data were examined to evaluate primary (technical and clinical success, complications) and secondary (worsening of esophageal varix [EV], change in liver function) end points. Median follow-up duration was 11 months, from 6.5 to 18 months. The Wilcoxon signed-rank test was used to compare laboratory data before and after the procedure. Results Technical success (complete occlusion of the efferent shunt and complete filling of gastric varix [GV] with a gelfoam slurry) was achieved in 18 of 19 (94.7%) patients. The embolic materials could not reach the GV in 1 patient who had endoscopic glue injection before our procedure. The clinical success rate (no recurrence of gastric variceal bleeding) was the same because the technically failed patient showed recurrent bleeding later. Acute complications included fever (n = 2), fever and hypotension (n = 2; one diagnosed adrenal insufficiency), and transient microscopic hematuria (n = 3). Ten patients underwent follow-up endoscopy; all exhibited GV improvement, except 2 without endoscopic change. Five patients exhibited aggravated EV, and 2 of them had a bleeding event. Laboratory findings were significantly improved after PARTO. Conclusion PARTO is technically feasible, safe, and effective for gastric variceal hemorrhage in patients with portal hypertension. PMID:26957908

  13. Finding of Biliary Fascioliasis by Endoscopic Ultrasonography in a Patient with Eosinophilic Liver Abscess

    PubMed Central

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

    2014-01-01

    Fascioliasis is an endemic zoonotic disease in Iran. It occurs mainly in sheep-rearing areas of temperate climates, but sporadic cases have been reported from many other parts of the world. The usual definitive host is the sheep. Humans are accidental hosts in the life cycle of Fasciola. Typical symptoms may be associated with fascioliasis, but in some cases diagnosis and treatment may be preceded by a long period of abdominal pain and vague gastrointestinal symptoms. We report a case with epigastric and upper quadrant abdominal pain for the last 6 months, with imaging suggesting liver abscess and normal biliary ducts. The patient had no eosinophilia with negative stool examinations, so she was initially treated with antibiotics for liver abscess. Her clinical condition as well as follow-up imagings showed appropriate response after antibiotic therapy. Finally, endoscopic ultrasonography revealed Fasciola hepatica, which was then extracted with endoscopic retrograde cholangiopancreatography. PMID:25473389

  14. Advances in endoscopic ultrasound-guided biliary drainage: a comprehensive review.

    PubMed

    Sarkaria, Savreet; Lee, Ho-Su; Gaidhane, Monica; Kahaleh, Michel

    2013-03-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the first-line therapy for bile duct drainage. In the hands of experienced endoscopists, conventional ERCP results in a failed cannulation rate of 3% to 5%. This failure can occur more commonly in the setting of altered anatomy or technically difficult cases due to either duodenal or biliary obstruction. In cases of ERCP failure, patients have traditionally been referred for either percutaneous transhepatic biliary drainage (PTBD) or surgery. However, both PTBD and surgery have higher than desirable complication rates. Within the last decade, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an attractive alternative to PTBD after failed ERCP. Many groups have reported on the feasibility, efficacy and safety of this technique. This article reviews the indications for ERCP and the currently practiced EUS-BD techniques, including EUS-guided rendezvous, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy. PMID:23560147

  15. Endoscopic simple prostatectomy

    PubMed Central

    Borkowski, Tomasz; Chłosta, Piotr; Dobruch, Jakub; Fiutowski, Marek; Jaskulski, Jarosław; Słojewski, Marcin; Szydełko, Tomasz; Szymański, Michał; Demkow, Tomasz

    2014-01-01

    Introduction Many options exist for the surgical treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), including transurethral resection of the prostate (TURP), laser surgery, and open adenomectomy. Recently, endoscopic techniques have been used in the treatment of BPH. Material and methods We reviewed clinical studies in PubMed describing minimally invasive endoscopic procedures for the treatment of BPH. Results Laparoscopic adenomectomy (LA) and robotic–assisted simple prostatectomy (RASP) were introduced in the early 2000s. These operative techniques have been standardized and reproducible, with some individual modifications. Studies analyzing the outcomes of LA and RASP have reported significant improvements in urinary flow and decreases in patient International Prostate Symptom Score (IPSS). These minimally invasive approaches have resulted in a lower rate of complications, shorter hospital stays, smaller scars, faster recoveries, and an earlier return to work. Conclusions Minimally invasive techniques such as LA and RASP for the treatment BPH are safe, efficacious, and allow faster recovery. These procedures have a short learning curve and offer new options for the surgeon treating BPH. PMID:25667758

  16. Endoscopic Total Thyroidectomy

    PubMed Central

    Duncan, Titus D.

    2009-01-01

    Background and Objective: Endoscopic neck surgery for the thyroid and parathyroid is being tested as an alternative to open thyroidectomy. The aim of this study was to determine the safety and feasibility of endoscopic transaxillary total thyroidectomy (ETTT). Methods and Results: Twenty-two consecutive patients from January 2006 to September 2008 underwent ETTT. No conversions to open were necessary. Mean age was 49.3±12.9 years, 20 were female, and 2 were male. Mean operating time was 238 minutes±72.7. Mean blood loss was 40mL±28.3mL. Mean weight of the gland was 137.05g±129.21g. The recurrent laryngeal nerve was identified with no permanent injury. Six patients developed hoarseness of the voice for a mean of 15.1±8.01 days. No patient developed tetany or hypocalcemia requiring treatment. Six patients experienced transient numbness in the anterior chest wall lasting 2 weeks in 5 patients and 2 months in one. All patients were discharged within 24 hours of admission. Conclusion: ETTT requires additional operative time compared with the open approach, but is cosmetically favorable. Visualization of the nerve and parathyroid is much better. Although the learning curve is steep, with experience the operative time will decrease. ETTT is different but safe and feasible. PMID:20202393

  17. Hydroperitoneum: A Rare Complication Performing Endoscopic Combined Intrarenal Surgery

    PubMed Central

    Nicolosi, Federico; Falsaperla, Mario; Saita, Alberto

    2016-01-01

    Abstract Background: Recently endoscopic combined intrarenal surgery (ECIRS) has been introduced as an innovative approach for the treatment of complex single, multiple, and staghorn urolithiasis, which reveals to be a viable alternative to standard percutaneous nephrolithotomy. Although considered to be a versatile, safe, and efficient endoscopic procedure, it is not free from complications. We would like to report two rare cases of hydroperitoneum that occurred during ECIRS and their management. Case Presentation: Two female patients, respectively, of 75 and 41 years of age, underwent ECIRS procedure for the treatment of complex staghorn kidney urolithiasis, previously evaluated by noncontrast computed tomography (CT) scan. A combined retrograde-percutaneous access to the intrarenal collecting system, under fluoroscopic and ultrasound guidance with the additional assistance of Endovision technique, was performed. At the end of the procedures, both patients revealed a taut and globous abdomen, and a perioperative CT and ultrasonography revealed the presence of intraperitoneal liquid. Both patients were effectively treated with immediate positioning of abdominal drain with rapid improvement of the clinical presentation. Conclusion: To our knowledge these are the first two cases of hydroperitoneum occurring during ECIRS and reported in the literature. An early detection of the complication and its prompt treatment revealed to be crucial to effectively prevent morbidity. PMID:27579417

  18. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy

    PubMed Central

    Ogura, Takeshi; Higuchi, Kazuhide

    2016-01-01

    Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur. PMID:27099437

  19. Emerging applications of endoscopic ultrasound in gastrointestinal cancers.

    PubMed

    Hernandez, Lyndon V; Bhutani, Manoop S

    2008-07-01

    Endoscopic ultrasound (EUS) has been adopted into numerous interventional techniques and strategies that promise to improve diagnosis and management of gastrointestinal (GI) cancers. EUS-guided fine-needle aspiration (EUS-FNA) is recommended as a procedure of choice for tissue diagnosis of pancreatic cancer. Potential benefits of EUS-FNA in diagnosis of pancreatic cancer include the ability to detect small, discrete lesions compared with conventional imaging and the ability to provide staging information by examination of blood vessels surrounding the pancreas. EUS-FNA currently is being evaluated in strategies for improving diagnosis in pancreatic cancer through analysis of molecular markers, including strategies for distinguishing malignant pancreatic cysts. EUS-guided fineneedle injection currently is being investigated in a broad range of settings in GI cancers, including use in intratumoral injection in pancreas and esophageal cancers, ethanol lavage for nonmalignant pancreatic cystic tumors, and brachytherapy in nonresectable pancreatic cancer. Other applications of EUS currently being evaluated include EUS-guided biliary access in patients with unsuccessful endoscopic retrograde cholangiopancreatography and EUS-guided anastamoses in the GI tract. EUS-guided interventions have enormous potential to advance diagnosis and treatment of GI cancers. PMID:19259286

  20. Technical tips for endoscopic ultrasound-guided hepaticogastrostomy.

    PubMed

    Ogura, Takeshi; Higuchi, Kazuhide

    2016-04-21

    Interventional procedures using endoscopic ultrasound (EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUS-guided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUS-guided hepaticogastrostomy (EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82% (221/270), the clinical success rate was 97% (218/225), and the overall adverse event rate for EUS-HGS was 23% (62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUS-HGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur. PMID:27099437

  1. Coil-Assisted Retrograde Transvenous Obliteration (CARTO) for the Treatment of Portal Hypertensive Variceal Bleeding: Preliminary Results

    PubMed Central

    Lee, Edward W; Saab, Sammy; Gomes, Antoinette S; Busuttil, Ronald; McWilliams, Justin; Durazo, Francisco; Han, Steven-Huy; Goldstein, Leonard; Tafti, Bashir A; Moriarty, John; Loh, Christopher T; Kee, Stephen T

    2014-01-01

    OBJECTIVES: To describe the technical feasibility, safety, and clinical outcomes of coil-assisted retrograde transvenous obliteration (CARTO) in treating portal hypertensive non-esophageal variceal hemorrhage. METHODS: From October 2012 to December 2013, 20 patients who received CARTO for the treatment of portal hypertensive non-esophageal variceal bleeding were retrospectively evaluated. All 20 patients had at least 6-month follow-up. All patients had detachable coils placed to occlude the efferent shunt and retrograde gelfoam embolization to achieve complete thrombosis/obliteration of varices. Technical success, clinical success, rebleeding, and complications were evaluated at follow-up. RESULTS: A 100% technical success rate (defined as achieving complete occlusion of efferent shunt with complete thrombosis/obliteration of bleeding varices and/or stopping variceal bleeding) was demonstrated in all 20 patients. Clinical success rate (defined as no variceal rebleeding) was 100%. Follow-up computed tomography after CARTO demonstrated decrease in size with complete thrombosis and disappearance of the varices in all 20 patients. Thirteen out of the 20 had endoscopic confirmation of resolution of varices. Minor post-CARTO complications, including worsening of esophageal varices (not bleeding) and worsening of ascites/hydrothorax, were noted in 5 patients (25%). One patient passed away at 24 days after the CARTO due to systemic and portal venous thrombosis and multi-organ failure. Otherwise, no major complication was noted. No variceal rebleeding was noted in all 20 patients during mean follow-up of 384±154 days. CONCLUSIONS: CARTO appears to be a technically feasible and safe alternative to traditional balloon-occluded retrograde transvenous obliteration or transjugular intrahepatic portosystemic shunt, with excellent clinical outcomes in treating portal hypertensive non-esophageal variceal bleeding. PMID:25273155

  2. Endoscopic management of esophageal varices

    PubMed Central

    Poza Cordon, Joaquin; Froilan Torres, Consuelo; Burgos García, Aurora; Gea Rodriguez, Francisco; Suárez de Parga, Jose Manuel

    2012-01-01

    The rupture of gastric varices results in variceal hemorrhage, which is one the most lethal complications of cirrhosis. Endoscopic therapies for varices aim to reduce variceal wall tension by obliteration of the varix. The two principal methods available for esophageal varices are endoscopic sclerotherapy (EST) and band ligation (EBL). The advantages of EST are that it is cheap and easy to use, and the injection catheter fits through the working channel of a diagnostic gastroscope. Endoscopic variceal ligation obliterates varices by causing mechanical strangulation with rubber bands. The following review aims to describe the utility of EBL and EST in different situations, such as acute bleeding, primary and secondary prophylaxis PMID:22816012

  3. Guideline Implementation: Processing Flexible Endoscopes.

    PubMed

    Bashaw, Marie A

    2016-09-01

    The updated AORN "Guideline for processing flexible endoscopes" provides guidance to perioperative, endoscopy, and sterile processing personnel for processing all types of reusable flexible endoscopes and accessories in all procedural settings. This article focuses on key points of the guideline to help perioperative personnel safely and effectively process flexible endoscopes to prevent infection transmission. The key points address verification of manual cleaning, mechanical cleaning and processing, storage in a drying cabinet, determination of maximum storage time before reprocessing is needed, and considerations for implementing a microbiologic surveillance program. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:27568535

  4. [Endoscopic management of biliary stones].

    PubMed

    Barinagarrementería, R

    1990-07-01

    Endoscopic sphincterotomy is one of the more effective therapeutic procedures for the management of some biliary tree abnormalities. In choledocolitiasis, a 90% succesfull rate has been obtained. Complications include bleeding, perforation, cholangitis, and pancreatitis. Mortality rates between 1.0 to 1.3% are informed. Contraindications are the same as for panendoscopy as well as the presence of stones greater than 2.5 cms. In giant stones, some other endoscopic approaches can be used, including mechanical lithotripsy, chemical treatment, electrohydraulic shockwaves, laser and biliary stent application. Endoscopic sphincterotomy is also indicated as an adjuvant therapy previous to extracorporeal lithotripsy. PMID:19256137

  5. Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?

    PubMed

    Fujisawa, Toshio; Kagawa, Koichi; Hisatomi, Kantaro; Kubota, Kensuke; Nakajima, Atsushi; Matsuhashi, Nobuyuki

    2016-07-14

    Endoscopic papillary balloon dilatation (EPBD) is useful for decreasing early complications of endoscopic retrograde cholangio-pancreatography (ERCP), including bleeding, biliary infection, and perforation, but it is generally avoided in Western countries because of a relatively high reported incidence of post-ERCP pancreatitis (PEP). However, as the efficacy of endoscopic papillary large-balloon dilatation (EPLBD) becomes widely recognized, EPBD is attracting attention. Here we investigate whether EPBD is truly a risk factor for PEP, and seek safer and more effective EPBD procedures by reviewing past studies. We reviewed thirteen randomised control trials comparing EPBD and endoscopic sphincterotomy (EST) and ten studies comparing direct EPLBD and EST. Three randomized controlled trials of EPBD showed significantly higher incidence of PEP than EST, but no study of EPLBD did. Careful analysis of these studies suggested that longer and higher-pressure inflation of balloons might decrease PEP incidence. The paradoxical result that EPBD with small-calibre balloons increases PEP incidence while EPLBD does not may be due to insufficient papillary dilatation in the former. Insufficient dilatation could cause the high incidence of PEP through the use of mechanical lithotripsy and stress on the papilla at the time of stone removal. Sufficient dilation of the papilla may be useful in preventing PEP. PMID:27468185

  6. Is endoscopic papillary balloon dilatation really a risk factor for post-ERCP pancreatitis?

    PubMed Central

    Fujisawa, Toshio; Kagawa, Koichi; Hisatomi, Kantaro; Kubota, Kensuke; Nakajima, Atsushi; Matsuhashi, Nobuyuki

    2016-01-01

    Endoscopic papillary balloon dilatation (EPBD) is useful for decreasing early complications of endoscopic retrograde cholangio-pancreatography (ERCP), including bleeding, biliary infection, and perforation, but it is generally avoided in Western countries because of a relatively high reported incidence of post-ERCP pancreatitis (PEP). However, as the efficacy of endoscopic papillary large-balloon dilatation (EPLBD) becomes widely recognized, EPBD is attracting attention. Here we investigate whether EPBD is truly a risk factor for PEP, and seek safer and more effective EPBD procedures by reviewing past studies. We reviewed thirteen randomised control trials comparing EPBD and endoscopic sphincterotomy (EST) and ten studies comparing direct EPLBD and EST. Three randomized controlled trials of EPBD showed significantly higher incidence of PEP than EST, but no study of EPLBD did. Careful analysis of these studies suggested that longer and higher-pressure inflation of balloons might decrease PEP incidence. The paradoxical result that EPBD with small-calibre balloons increases PEP incidence while EPLBD does not may be due to insufficient papillary dilatation in the former. Insufficient dilatation could cause the high incidence of PEP through the use of mechanical lithotripsy and stress on the papilla at the time of stone removal. Sufficient dilation of the papilla may be useful in preventing PEP. PMID:27468185

  7. Lumbar spinal epidural arteriovenous fistula with perimedullary venous drainage after endoscopic lumbar surgery

    PubMed Central

    Murakami, Toshiharu; Wada, Takeshi; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2015-01-01

    Spinal epidural arteriovenous fistulas (AVFs) with perimedullary venous drainage are rare. This report describes a case of lumbar epidural AVF in a patient with a history of endoscopic lumbar discectomy at the same level 8 years prior to presenting with progressive myelopathy secondary to retrograde venous reflux into the perimedullary vein. A 69-year-old man presented with progressive lower extremity weakness and sensory disturbance and loss of sphincter control 8 years after endoscopic lumbar discectomy for a disc herniation at L4–5 level. Magnetic resonance imaging showed spinal cord edema and dilated intradural perimedullary vessels. Spinal angiography revealed an epidural AVF at the site of the previous endoscopic lumbar surgery with intradural perimedullary venous drainage. The fistula was successfully occluded via endovascular transarterial embolization, and the patient had stabilization of his neurological deficits. Lumbar spinal epidural AVFs, especially those associated with iatrogenic trauma, are rare. Endoscopic surgical procedure can occlude the epidural venous plexus and disturb venous drainage, thereby inducing local venous hypertension and leading to epidural AVF with perimedullary venous drainage. This type of pathology should be considered within the differential diagnosis of delayed neurological deterioration after spinal surgery. PMID:25948114

  8. Endocoil placement after endoscopic ultrasound-guided biliary drainage may prevent a bile leak

    PubMed Central

    van der Merwe, Schalk Willem; Omoshoro-Jones, Jones; Sanyika, Charles

    2013-01-01

    AIM: To further reduce the risk of bleeding or bile leakage. METHODS: We performed endoscopic ultrasound guided biliary drainage in 6 patients in whom endoscopic retrograde cholangiopancreatography (ERCP) had failed. Biliary access of a dilated segment 2 or 3 duct was achieved from the stomach using a 19G needle. After radiologically confirming access a guide wire was placed, a transhepatic tract created using a 6 Fr cystotome followed by balloon dilation of the stricture and antegrade metallic stent placement across the malignant obstruction. This was followed by placement of an endocoil in the transhepatic tract. RESULTS: Dilated segmental ducts were observed in all patients with the linear endoscopic ultrasound scope from the proximal stomach. Transgastric biliary access was obtained using a 19G needle in all patients. Biliary drainage was achieved in all patients. Placement of an endocoil was possible in 5/6 patients. All patients responded to biliary drainage and no complications occurred. CONCLUSION: We show that placing endocoils at the time of endoscopic ultrasound guided biliary stenting is feasible and may reduce the risk of bleeding or bile leakage. PMID:23678378

  9. Endoscopic removal of a spontaneously fractured biliary uncovered self-expandable metal stent.

    PubMed

    Kawakubo, Kazumichi; Isayama, Hiroyuki; Tsujino, Takeshi; Nakai, Yousuke; Sasahira, Naoki; Kogure, Hirofumi; Hamada, Tsuyoshi; Nagano, Rie; Miyabayashi, Kouji; Yamamoto, Keisuke; Mohri, Dai; Sasaki, Takashi; Ito, Yukiko; Yamamoto, Natsuyo; Hirano, Kenji; Tada, Minoru; Koike, Kazuhiko

    2012-05-01

    Self-expandable metal stents (SEMS) are widely used for the palliative treatment of unresectable malignant biliary obstruction. However, the long-term durability of SEMSs in biliary strictures is not clear. We describe a case of endoscopic removal of spontaneously fractured uncovered biliary SEMS. A 59-year-old woman presented to our institution with a 1-year history of recurrent cholangitis. Her medical history included a proctectomy for rectal cancer and right hemihepatectomy for liver metastasis 10 years earlier. Five years after these operations, she developed a benign hilar stricture and had an uncovered SEMS placed in another hospital. Endoscopic retrograde cholangiopancreatography demonstrated that the SEMS was torn in half and the distal part of the stent was floating in the dilated common bile duct. The papillary orifice was dilated by endoscopic papillary large balloon dilation (EPLBD) using a 15-mm wire-guided balloon catheter. Subsequently, we inserted biopsy forceps into the bile duct and grasped the distal end of the broken SEMS under fluoroscopy. We successfully removed the fragment of the SEMS from the bile duct, along with the endoscope. The patient was discharged without complications. Placement of an uncovered biliary SEMS is not the preferred treatment for benign biliary strictures. Spontaneous fracture of an uncovered biliary SEMS is an extremely rare complication. We should be aware that stent fracture can occur when placing uncovered biliary SEMSs in patients with a long life expectancy. EPLBD is very useful for retrieving the fractured fragment of SEMS. PMID:22507093

  10. Improving patient and user safety during endoscopic investigation of the pancreatic and biliary ducts

    NASA Astrophysics Data System (ADS)

    Chandler, John E.; Melville, C. David; Lee, Cameron M.; Saunders, Michael D.; Burkhardt, Matthew R.; Seibel, Eric J.

    2011-03-01

    Endoscopic investigation of the main pancreatic duct and biliary ducts is called endoscopic retrograde cholangiopancreatography (ERCP), and carries a risk of pancreatitis for the patient. During ERCP, a metal guidewire is inserted into the pancreatobiliary duct from a side-viewing large endoscope within the duodenum. To verify correct placement of the ERCP guidewire, an injection of radiopaque dye is required for fluoroscopic imaging, which exposes the patient and clinical team to x-ray radiation. A safer and more effective means to access the pancreatobiliary system can use direct optical imaging, although the endoscope diameter and stiffness will be significantly larger than a guidewire's. To quantify this invasiveness before human testing, a synthetic force-sensing pancreas was fabricated and attached to an ERCP training model. The invasiveness of a new, 1.7-mm diameter, steerable scanning fiber endoscope (SFE) was compared to the standard ERCP guidewire of 0.89-mm (0.035") diameter that is not steerable. Although twice as large and significantly stiffer than the ERCP guidewire, the SFE generated lower or significantly less average force during insertion at all 4 sensor locations (P<0.05) within the main pancreatic duct. Therefore, the addition of steering and forward visualization at the tip of the endoscope reduced the invasiveness of the in vitro ERCP procedure. Since fluoroscopy is not required, risks associated with dye injection and x-ray exposure can be eliminated when using direct optical visualization. Finally, the SFE provides wide-field high resolution imaging for image-guided interventions, laser-based fluorescence biomarker imaging, and spot spectral analysis for future optical biopsy.

  11. Eleven-year experience on the endoscopic treatment of post-cholecystectomy bile leaks

    PubMed Central

    Fasoulas, Kostas; Zavos, Christos; Chatzimavroudis, Grigoris; Trakateli, Christina; Vasiliadis, Themistoklis; Ioannidis, Aristidis; Kountouras, Jannis; Katsinelos, Panagiotis

    2011-01-01

    Background Bile leak is a common and serious complication of cholecystectomy with endotherapy being an established method of treatment. This retrospective study presents the 11-year experience of a referral center in endoscopic management of post-cholecystectomy bile leaks. Methods During the period between January 2000 and December 2010, records of patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for suspected post-cholecystectomy bile leaks were reviewed for evidence of clinical presentation of bile leaks, cholangiographic findings, type of endoscopic intervention, procedural complications and post-procedure follow-up. Results Seventy-one patients with suspected post-cholecystectomy bile leak were referred for ERCP. Common bile duct (CBD) cannulation was successful in 70 patients (98.59%). Complete transection of CBD was diagnosed in 4 patients; they were treated with surgery. A leak from the cystic duct stump was demonstrated in 49 patients (74.24%), from the ducts of Luschka in 4 (6.06%), from the gallbladder bed in 2 (3.03%), from the CBD in 7 (10.61%) and from the common hepatic duct (CHD) in 4 patients (6.06%). Endoscopic sphincterotomy (ES) plus endoprosthesis was performed in 64 patients (96.97%). A 12-year-old girl with a leak from cystic duct stump was successfully treated with stenting without ES and one patient with leak from gallbladder bed underwent only ES. Endoscopic intervention failed to treat a leak from CHD in one patient. During the follow-up, three patients developed bile duct stricture. Two were treated endoscopically and one with hepaticojejunostomy. Conclusions ES plus large-bore straight plastic biliary stent placement is a safe and effective intervention in post-cholecystectomy bile leaks. PMID:24713781

  12. Cost-Utility of Competing Strategies to Prevent Endoscopic Transmission of Carbapenem-Resistant Enterobacteriaceae

    PubMed Central

    Almario, Christopher V.; May, Folasade P.; Shaheen, Nicholas J.; Murthy, Rekha; Gupta, Kapil; Jamil, Laith H.; Lo, Simon K.; Spiegel, Brennan M.R.

    2015-01-01

    OBJECTIVES Prior reports have linked patient transmission of carbapenem-resistant Enterobacteriaceae (CRE, or “superbug”) to endoscopes used during endoscopic retrograde cholangiopancreatography (ERCP). We performed a decision analysis to measure the cost-effectiveness of four competing strategies for CRE risk management. METHODS We used decision analysis to calculate the cost-effectiveness of four approaches to reduce the risk of CRE transmission among patients presenting to the hospital for symptomatic common bile duct stones. The strategies included: (1) perform ERCP followed by U.S. Food and Drug Administration (FDA)-recommended endoscope reprocessing procedures; (2) perform ERCP followed by “endoscope culture and hold”; (3) perform ERCP followed by ethylene oxide (EtO) sterilization of the endoscope; and (4) stop performing ERCP in lieu of laparoscopic cholecystectomy (LC) with common bile duct exploration (CBDE). Our outcome was incremental cost per quality-adjusted life year (QALY) gained. RESULTS In the base-case scenario, ERCP with FDA-recommended endoscope reprocessing was the most cost-effective strategy. Both the ERCP with culture and hold ($4,228,170/QALY) and ERCP with EtO sterilization ($50,572,348/QALY) strategies had unacceptable incremental costs per QALY gained. LC with CBDE was dominated, being both more costly and marginally less effective versus the alternatives. In sensitivity analysis, ERCP with culture and hold became the most cost-effective approach when the pretest probability of CRE exceeded 24%. CONCLUSIONS In institutions with a low CRE prevalence, ERCP with FDA-recommended reprocessing is the most cost-effective approach for mitigating CRE transmission risk. Only in settings with an extremely high CRE prevalence did ERCP with culture and hold become cost-effective. PMID:26526083

  13. Successful Endoscopic Management of Acute Necrotic Pancreatitis and Walled Off Necrosis After Auxiliary Partial Orthotopic Living-Donor Liver Transplantation: A Case Report.

    PubMed

    Kobayashi, T; Miura, K; Ishikawa, H; Soma, D; Zhang, Z; Yuza, K; Hirose, Y; Takizawa, K; Nagahashi, M; Sakata, J; Kameyama, H; Kosugi, S; Wakai, T

    2016-05-01

    Endoscopic management of acute necrotic pancreatitis and walled off necrosis is less invasive than surgical treatment and has become the 1st choice for treating pancreatic necrosis and abscess. We treated a case of acute necrotic pancreatitis and walled off necrosis after auxiliary partial orthotopic living-donor liver transplantation (APOLT). A 24-year-old woman was admitted to our university hospital for removal of the internal biliary stent, which had already been placed endoscopically for the treatment of biliary stricture after APOLT. She had been treated for acute liver failure by APOLT 10 years before. After we removed the internal stent with the use of an endoscopic retrograde approach, she presented with severe abdominal pain and a high fever. Her diagnosis was severe acute pancreatitis after endoscopic retrograde cholangiography (ERC). Her symptoms worsened, and she had multiple organ failure. She was transferred to the intensive care unit (ICU). Immunosuppression was discontinued because infection treatment was necessary and the native liver had already recovered sufficiently. After she had been treated for 19 days in the ICU, she recovered from her multiple organ failure. However, abdominal computerized tomography demonstrated the formation of pancreatic walled off necrosis and an abscess on the 20th day after ERC. We performed endoscopic ultrasonography-guided abscess drainage and repeated endoscopic necrosectomy. The walled off necrosis diminished gradually in size, and the symptoms disappeared. The patient was discharged on the 87th day after ERC. This is the 1st report of a case of acute necrotic pancreatitis and walled off necrosis that was successfully treated by endoscopic management after APOLT. PMID:27320589

  14. Endoscopic surgery - exploring the modalities

    PubMed Central

    Lee, Daniel Jin Keat; Tan, Kok-Yang

    2015-01-01

    The adoption of endoscopic surgery continues to expand in clinical situations with the recent natural orifice transluminal endoscopic surgery technique enabling abdominal organ resection to be performed without necessitating any skin incision. In recent years, the development of numerous devices and platforms have allowed for such procedures to be carried out in a safer and more efficient manner, and in some ways to better simulate triangulation and surgical tasks (e.g., suturing and dissection). Furthermore, new novel techniques such as submucosal tunneling, endoscopic full-thickness resection and hybrid endo-laparoscopic approaches have further widened its use in more advanced diseases. Nevertheless, many of these new innovations are still at their pre-clinical stage. This review focuses on the various innovations in endoscopic surgery, with emphasis on devices and techniques that are currently in human use. PMID:26649156

  15. Celiac Disease Diagnosis: Endoscopic Biopsy

    MedlinePlus

    ... This is done in a procedure called a biopsy: the physician eases a long, thin tube called ... the tissue using instruments passed through the endoscope. Biopsy of the small intestine is the only way ...

  16. Foveated endoscopic lens

    PubMed Central

    Hagen, Nathan

    2012-01-01

    Abstract. We present a foveated miniature endoscopic lens implemented by amplifying the optical distortion of the lens. The resulting system provides a high-resolution region in the central field of view and low resolution in the outer fields, such that a standard imaging fiber bundle can provide both the high resolution needed to determine tissue health and the wide field of view needed to determine the location within the inspected organ. Our proof of concept device achieves 7∼8  μm resolution in the fovea and an overall field of view of 4.6 mm. Example images and videos show the foveated lens’ capabilities. PMID:22463022

  17. Endoscopic third ventriculostomy

    PubMed Central

    Yadav, Yad Ram; Parihar, Vijay; Pande, Sonjjay; Namdev, Hemant; Agarwal, Moneet

    2012-01-01

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

  18. Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis.

    PubMed

    Lui, Tun Hing

    2016-04-01

    Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion. PMID:27462544

  19. Endoscopic Management of Portal Hypertension

    PubMed Central

    Al-Busafi, Said A.; Ghali, Peter; Wong, Philip; Deschenes, Marc

    2012-01-01

    Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices. PMID:22830037

  20. Study of the prograde and retrograde Chandler excitation

    NASA Astrophysics Data System (ADS)

    Zotov, , L.; Bizouard, , C.

    2014-12-01

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

  1. Fundamental studies of retrograde reactions in direct liquefaction

    SciTech Connect

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

    1991-12-17

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

  2. Endoscopic treatment of pancreatic calculi.

    PubMed

    Kim, Yong Hoon; Jang, Sung Ill; Rhee, Kwangwon; Lee, Dong Ki

    2014-05-01

    Chronic pancreatitis is a progressive inflammatory disease that destroys pancreatic parenchyma and alters ductal stricture, leading to ductal destruction and abdominal pain. Pancreatic duct stones (PDSs) are a common complication of chronic pancreatitis that requires treatment to relieve abdominal pain and improve pancreas function. Endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and surgery are treatment modalities of PDSs, although lingering controversies have hindered a consensus recommendation. Many comparative studies have reported that surgery is the superior treatment because of reduced duration and frequency of hospitalization, cost, pain relief, and reintervention, while endoscopic therapy is effective and less invasive but cannot be used in all patients. Surgery is the treatment of choice when endoscopic therapy has failed, malignancy is suspected, or duodenal stricture is present. However, in patients with the appropriate indications or at high-risk for surgery, endoscopic therapy in combination with ESWL can be considered a first-line treatment. We expect that the development of advanced endoscopic techniques and equipment will expand the role of endoscopic treatment in PDS removal. PMID:24944986

  3. Large retrograde Centaurs: visitors from the Oort cloud?

    NASA Astrophysics Data System (ADS)

    de la Fuente Marcos, C.; de la Fuente Marcos, R.

    2014-08-01

    Among all the asteroid dynamical groups, Centaurs have the highest fraction of objects moving in retrograde orbits. The distribution in absolute magnitude, H, of known retrograde Centaurs with semi-major axes in the range 6-34 AU exhibits a remarkable trend: 10 % have H<10 mag, the rest have H>12 mag. The largest objects, namely (342842) 2008 YB3, 2011 MM4 and 2013 LU28, move in almost polar, very eccentric paths; their nodal points are currently located near perihelion and aphelion. In the group of retrograde Centaurs, they are obvious outliers both in terms of dynamics and size. Here, we show that these objects are also trapped in retrograde resonances that make them unstable. Asteroid 2013 LU28, the largest, is a candidate transient co-orbital to Uranus and it may be a recent visitor from the trans-Neptunian region. Asteroids 342842 and 2011 MM4 are temporarily submitted to various high-order retrograde resonances with the Jovian planets but 342842 may be ejected towards the trans-Neptunian region within the next few hundred kyr. Asteroid 2011 MM4 is far more stable. Our analysis shows that the large retrograde Centaurs form an heterogeneous group that may include objects from various sources. Asteroid 2011 MM4 could be a visitor from the Oort cloud but an origin in a relatively stable closer reservoir cannot be ruled out. Minor bodies like 2011 MM4 may represent the remnants of the primordial planetesimals and signal the size threshold for catastrophic collisions in the early Solar System.

  4. Dynein is the motor for retrograde axonal transport of organelles

    SciTech Connect

    Schnapp, B.J.; Reese, T.S.

    1989-03-01

    Vesicular organelles in axons of nerve cells are transported along microtubules either toward their plus ends (fast anterograde transport) or toward their minus ends (retrograde transport). Two microtubule-based motors were previously identified by examining plastic beads induced to move along microtubules by cytosol fractions from the squid giant axon: (i) an anterograde motor, kinesin, and (ii) a retrograde motor, which is characterized here. The retrograde motor, a cytosolic protein previously termed HMW1, was purified from optic lobes and extruded axoplasm by nucleotide-dependent microtubule affinity and release; microtubule gliding was used as the assay of motor activity. The following properties of the retrograde motor suggest that it is cytoplasmic dynein: (i) sedimentation at 20-22 S with a heavy chain of Mr greater than 200,000 that coelectrophoreses with the alpha and beta subunits of axonemal dynein, (ii) cleavage by UV irradiation in the presence of ATP and vanadate, and (iii) a molecular structure resembling two-headed dynein from axonemes. Furthermore, bead movement toward the minus end of microtubules was blocked when axoplasmic supernatants were treated with UV/vanadate. Treatment of axoplasmic supernatant with UV/vanadate also blocks the retrograde movement of purified organelles in vitro without changing the number of anterograde moving organelles, indicating that dynein interacts specifically with a subgroup of organelles programmed to move toward the cell body. However, purified optic lobe dynein, like purified kinesin, does not by itself promote the movement of purified organelles along microtubules, suggesting that additional axoplasmic factors are necessary for retrograde as well as anterograde transport.

  5. Transcatheter closure of ruptured sinus Valsalva aneurysm with retrograde approach.

    PubMed

    Narin, Nazmi; Ozyurt, Abdullah; Baykan, Ali; Uzüm, Kazım

    2014-04-01

    A three-year-old girl with multiple heart malformations admitted to the pediatric cardiology unit because of excessive sweating and fatigue. Abnormal color Doppler flow was detected into the right atrium from the dilated coronary sinus on the echocardiographic examination, and ruptured sinus Valsalva aneurysm (SVA) was diagnosed. Although in most such cases, an antegrade transcatheter approach has been used, a retrograde approach can be used as a cost-effective treatment modality in those cases with selective high-risk surgery. In this report, we present a patient with ruptured SVA, which was closed via Amplatzer vascular plug-4 by retrograde approach. PMID:24769826

  6. Orbital Evolution and Impact Hazard of Asteroids on Retrograde Orbits

    NASA Astrophysics Data System (ADS)

    Kankiewicz, P.; Włodarczyk, I.

    2014-07-01

    We present the past evolutional scenarios of known group of asteroids in retrograde orbits. Applying the latest observational data, we determined their nominal and averaged orbital elements. Next, we studied the behaviour of their orbital motion 1~My in the past (100~My in the future for two NEAs) taking into account the limitations of observational errors. It has been shown that the influence of outer planets perturbations in many cases can import small bodies on high inclination or retrograde orbits into the inner Solar System.

  7. Ensuring the Safety of Your Endoscopic Procedure

    MedlinePlus

    ... an endoscope are as follows: Mechanical cleaning The operating channels and external portions of the endoscope are ... that there are no leaks in its internal operating channels. This not only ensures peak performance of ...

  8. [Ultra-thin transnasal esophagogastroduodenoscopy].

    PubMed

    Kawai, Takashi; Yamamoto, Kei; Fukuzawa, Mari; Sakai, Yoshihiro; Moriyasu, Fuminori

    2010-07-01

    It is reported that ultra-thin transnasal esophagogastroduodenoscopy (TN-EGD) reduces pharyngeal discomfort and is more tolerable for the patients. Ultra-thin transnasal endoscopy has been reported as inferior to transoral conventional EGD (TO-EGD) in terms of image quality, suction, air insufflation and lens washing, due to the smaller endoscope caliber. TN-EGD should be conducted slowly, with short distance observation, and also with image-enhanced endoscopy. With reference to image-enhanced endoscopy, chromoendoscopy method (indigocarmine) is suitable for gastric neoplasm, on the other hand optical digital method (NBI) and digital method (i-scan, FICE) is suitable for esophageal neoplasm. TN-EGD is applied in various gastrointestinal (GI) procedures such as percutaneous endoscopic gastrostomy, nasoenteric feeding tube placement, endoscopic retrograde cholangiopancreaticography with nasobiliary drainage, long intestinal tube placement in small bowel obstruction, esophageal manometry. PMID:20662204

  9. Chloroplast Retrograde Regulation of Heat Stress Responses in Plants.

    PubMed

    Sun, Ai-Zhen; Guo, Fang-Qing

    2016-01-01

    It is well known that intracellular signaling from chloroplast to nucleus plays a vital role in stress responses to survive environmental perturbations. The chloroplasts were proposed as sensors to heat stress since components of the photosynthetic apparatus housed in the chloroplast are the major targets of thermal damage in plants. Thus, communicating subcellular perturbations to the nucleus is critical during exposure to extreme environmental conditions such as heat stress. By coordinating expression of stress specific nuclear genes essential for adaptive responses to hostile environment, plants optimize different cell functions and activate acclimation responses through retrograde signaling pathways. The efficient communication between plastids and the nucleus is highly required for such diverse metabolic and biosynthetic functions during adaptation processes to environmental stresses. In recent years, several putative retrograde signals released from plastids that regulate nuclear genes have been identified and signaling pathways have been proposed. In this review, we provide an update on retrograde signals derived from tetrapyrroles, carotenoids, reactive oxygen species (ROS) and organellar gene expression (OGE) in the context of heat stress responses and address their roles in retrograde regulation of heat-responsive gene expression, systemic acquired acclimation, and cellular coordination in plants. PMID:27066042

  10. A systematic review of in vitro retrograde obturation materials.

    PubMed

    Theodosopoulou, Joanna N; Niederman, Richard

    2005-05-01

    The purpose of this review was two-fold: (a) to determine which retrograde obturation material(s) best prevents dye/ink penetration in vitro; and (b) to determine whether in vitro results agree with in vivo results. A MEDLINE search was conducted to identify in vitro studies published between January 1966 and October, week 4, 2003, conducted on human teeth, and published in English, German, or French language, testing the resistance to retrograde penetration of retrograde filling materials. The MEDLINE search identified 278 published articles. Of those, 115 studies examined the resistance to penetration of various retrograde filling materials, in vitro. Thirty-four studies met all the inclusion and validity criteria. The results indicate that, beyond 10 days in vitro, the most effective retrofilling materials, when measured by dye/ink penetration are: composites>glass ionomer cement>amalgam>orthograde gutta-percha>EBA. The results of these in vitro studies are not congruent with in vivo study results, suggesting a need to re-evaluate the clinical validity and importance of in vitro studies. PMID:15851926

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

    PubMed

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

    2006-09-01

    The water dynamics and retrogradation kinetics behavior of gelatinized wheat starch by either ultrahigh pressure (UHP) processing or heat are investigated. Wheat starch completely gelatinized in the condition of 90, 000 psi at 25 degrees C for 30 min (pressurized gel) or 100 degrees C for 30 min (heated gel). The physical properties of the wheat starches were characterized in terms of proton relaxation times (T2 times) measured using time-domain nuclear magnetic resonance spectroscopy and evaluated using commercially available continuous distribution modeling software. Different T2 distributions in both micro- and millisecond ranges between pressurized and heated wheat starch gels suggest distinctively different water dynamics between pressurized and heated wheat starch gels. Smaller water self-diffusion coefficients were observed for pressurized wheat starch gels and are indicative of more restricted translational proton mobility than is observed with heated wheat starch gels. The physical characteristics associated with changes taking place during retrogradation were evaluated using melting curves obtained with differential scanning calorimetry. Less retrogradation was observed in pressurized wheat starch, and it may be related to a smaller quantity of freezable water in pressurized wheat starch. Starches comprise a major constituent of many foods proposed for commercial potential using UHP, and the present results furnish insight into the effect of UHP on starch gelatinization and the mechanism of retrogradation during storage. PMID:16939331

  12. The kinematics of turnaround and retrograde axonal transport.

    PubMed

    Snyder, R E

    1986-11-01

    Rapid axonal transport of a pulse of 35S-methionine-labelled material was studied in vitro in the sensory neurons of amphibian sciatic nerve using a position-sensitive detector. For 10 nerves studied at 23.0 +/- 0.2 degrees C it was found that a pulse moved in the anterograde direction characterized by front edge, peak, and trailing edge transport rates of (mm/d) 180.8 +/- 2.2 (+/- SEM), 176.6 +/- 2.3, and 153.7 +/- 3.0, respectively. Following its arrival at a distal ligature, a smaller pulse was observed to move in the retrograde direction characterized by front edge and peak transport rates of 158.0 +/- 7.3 and 110.3 +/- 3.5, respectively, indicating that retrograde transport proceeds at a rate of 0.88 +/- 0.04 that of anterograde. The retrograde pulse was observed to disperse at a rate greater than the anterograde. Reversal of radiolabel at the distal ligature began 1.49 +/- 0.15 h following arrival of the first radiolabel. Considerable variation was seen between preparations in the way radiolabel accumulated in the end (ligature) regions of the nerve. Although a retrograde pulse was seen in all preparations, in 7 of 10 preparations there was no evidence of this pulse accumulating within less than 2-3 mm of a proximal ligature; however, accumulation was observed within less than 5 mm in all preparations. PMID:2432169

  13. Chloroplast Retrograde Regulation of Heat Stress Responses in Plants

    PubMed Central

    Sun, Ai-Zhen; Guo, Fang-Qing

    2016-01-01

    It is well known that intracellular signaling from chloroplast to nucleus plays a vital role in stress responses to survive environmental perturbations. The chloroplasts were proposed as sensors to heat stress since components of the photosynthetic apparatus housed in the chloroplast are the major targets of thermal damage in plants. Thus, communicating subcellular perturbations to the nucleus is critical during exposure to extreme environmental conditions such as heat stress. By coordinating expression of stress specific nuclear genes essential for adaptive responses to hostile environment, plants optimize different cell functions and activate acclimation responses through retrograde signaling pathways. The efficient communication between plastids and the nucleus is highly required for such diverse metabolic and biosynthetic functions during adaptation processes to environmental stresses. In recent years, several putative retrograde signals released from plastids that regulate nuclear genes have been identified and signaling pathways have been proposed. In this review, we provide an update on retrograde signals derived from tetrapyrroles, carotenoids, reactive oxygen species (ROS) and organellar gene expression (OGE) in the context of heat stress responses and address their roles in retrograde regulation of heat-responsive gene expression, systemic acquired acclimation, and cellular coordination in plants. PMID:27066042

  14. Clinical Practice Guidelines for Endoscope Reprocessing

    PubMed Central

    Oh, Hyun Jin

    2015-01-01

    Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process. PMID:26473117

  15. Endoscopic submucosal dissection.

    PubMed

    Maple, John T; Abu Dayyeh, Barham K; Chauhan, Shailendra S; Hwang, Joo Ha; Komanduri, Sri; Manfredi, Michael; Konda, Vani; Murad, Faris M; Siddiqui, Uzma D; Banerjee, Subhas

    2015-01-01

    ESD is an established effective treatment modality for premalignant and early-stage malignant lesions of the stomach, esophagus, and colorectum. Compared with EMR, ESD is generally associated with higher rates of en bloc, R0, and curative resections and a lower rate of local recurrence. Oncologic outcomes with ESD compare favorably with competing surgical interventions, and ESD also serves as an excellent T-staging tool to identify noncurative resections that will require further treatment. ESD is technically demanding and has a higher rate of adverse events than most endoscopic procedures including EMR. As such,sufficient training is critical to ensure safe conduct and high-quality resections. A standardized training model for Western endoscopists has not been clearly established,but will be self-directed and include courses, animal model training, and optimally an observership at an expert center.Numerous dedicated ESD devices are now available in the United States from different manufacturers. Although the use of ESD in the United States is increasing, issues related to technical difficulty, limited training opportunities and mentors, risk of adverse events, long procedure duration,and suboptimal reimbursement may limit ESD adoption in the United States to a modest number of academic referral centers for the foreseeable future. PMID:25796422

  16. Endoscopic Transaxillary Near Total Thyroidectomy

    PubMed Central

    Ejeh, Ijeoma Acholonu; Speights, Fredne; Rashid, Qammar N.; Ideis, Mustafa

    2006-01-01

    Background: Since first reported in 1996, endoscopic minimally invasive surgery of the cervical region has been shown to be safe and effective in the treatment of benign thyroid and parathyroid disease. The endoscopic transaxillary technique uses a remote lateral approach to the thyroid gland. Because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, this technique has typically been reserved for patients with unilateral disease. Objectives: The present study examines the safety and feasibility of the transaxillary technique in dissecting and assessment of both thyroid lobes in performing near total thyroidectomy. Methods: Prior to this study we successfully performed endoscopic transaxillary thyroid lobectomy in 32 patients between August 2003 and August 2005. Technical feasibility in performing total thyroidectomy using this approach was accomplished first utilizing a porcine model followed by three human cadaver models prior to proceeding to human surgery. After IRB approval three female patients with histories of enlarging multinodular goiter were selected to undergo endoscopic near total thyroidectomy. Results: The average operative time for all models was 142 minutes (range 57–327 min). The three patients in this study had clinically enlarging multinodular goiters with an average size of 4 cm. The contralateral recurrent laryngeal nerve and parathyroid glands were identified in all cases. There was no post-operative bleeding, hoarseness or subcutaneous emphysema. Conclusion: Endoscopic transaxillary near total thyroidectomy is feasible and can be performed safely in human patients with bilateral thyroid disease. PMID:16882421

  17. Retrograde fluids in granulites: Stable isotope evidence of fluid migration

    SciTech Connect

    Morrison, J. ); Valley, J.W. )

    1991-07-01

    Widespread retrograde alteration assemblages document the migration of mixed H{sub 2}O-CO{sub 2} fluids into granulite facies rocks in the Adirondack Mountains. Fluid migration is manifest by (1) veins and patchy intergrowths of chlorite {plus minus} sericite {plus minus} calcite, (2) small veins of calcite, many only identifiable by cathodoluminescence, and (3) high-density, CO{sub 2}-rich or mixed H{sub 2}O-CO{sub 2} fluid inclusions. The distinct and varied textural occurrences of the alteration minerals indicate that fluid-rock ratios were low and variable on a local scale. Stable isotope ratios of C, O, and S have been determined in retrograde minerals from samples of the Marcy anorthosite massif and adjacent granitic gneisses (charnockites). Retrograde calcite in the anorthosite has a relatively small range in both {delta}{sup 18}O{sub SMOW} and {delta}{sup 13}C{sub PDB} (8.6 to 14.9% and {minus}4.1 to 0.4%, respectively), probably indicating that the hydrothermal fluids that precipitated the calcite had exchanged with a variety of crustal lithologies including marbles and orthogneisses, and that calcite was precipitated over a relatively narrow temperature interval. Values of {delta}{sup 34}S{sub CDT} that range from 2.8 to 8.3% within the anorthosite can also be interpreted to reflect exchange between orthogneisses and metasediments. The recognition of retrograde fluid migration is particularly significant in granulite facies terranes because the controversy surrounding the origin of granulites arises in part from differing interpretations of fluid inclusion data, specifically, the timing of entrapment of high-density, CO{sub 2}-rich inclusions. Results indicate that retrograde fluid migration, which in some samples may leave only cryptic petrographic evidence, is a process capable of producing high-density, CO{sub 2}-rich fluid inclusions.

  18. Endoscopic Management of Bladder Diverticula.

    PubMed

    Pham, Khanh N; Jeldres, Claudio; Hefty, Thomas; Corman, John M

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  19. Motion magnification for endoscopic surgery

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Baxter, John S. H.; de Ribaupierre, Sandrine; Peters, Terry M.

    2014-03-01

    Endoscopic and laparoscopic surgeries are used for many minimally invasive procedures but limit the visual and haptic feedback available to the surgeon. This can make vessel sparing procedures particularly challenging to perform. Previous approaches have focused on hardware intensive intraoperative imaging or augmented reality systems that are difficult to integrate into the operating room. This paper presents a simple approach in which motion is visually enhanced in the endoscopic video to reveal pulsating arteries. This is accomplished by amplifying subtle, periodic changes in intensity coinciding with the patient's pulse. This method is then applied to two procedures to illustrate its potential. The first, endoscopic third ventriculostomy, is a neurosurgical procedure where the floor of the third ventricle must be fenestrated without injury to the basilar artery. The second, nerve-sparing robotic prostatectomy, involves removing the prostate while limiting damage to the neurovascular bundles. In both procedures, motion magnification can enhance subtle pulsation in these structures to aid in identifying and avoiding them.

  20. Catheter-based photoacoustic endoscope

    NASA Astrophysics Data System (ADS)

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

    2014-06-01

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

  1. Endoscopic Management of Bladder Diverticula

    PubMed Central

    Pham, Khanh N.; Jeldres, Claudio; Hefty, Thomas; Corman, John M.

    2016-01-01

    A 50-year-old man with benign prostatic hyperplasia and urinary retention had a very large diverticulum on the posterior wall of the bladder. The patient was managed with transurethral resection of the prostate and endoscopic fulguration of the bladder diverticulum mucosa using the Orandi technique. There was near-complete resolution of the bladder diverticulum following endoscopic management, obviating the need for bladder diverticulectomy. The patient now empties his bladder, with a postvoid residual < 50 mL and the absence of urinary tract infection after 6-month follow-up. We report the successful treatment of a large bladder diverticulum with endoscopic fulguration to near-complete resolution. This minimally invasive technique is a useful alternative in patients unfit for a more extensive surgical approach. PMID:27601971

  2. Hemostasis in Endoscopic Sinus Surgery.

    PubMed

    Pant, Harshita

    2016-06-01

    Intraoperative bleeding during endoscopic sinus surgery poses an additional dimension to an already technically challenging surgical approach because of the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments. Poor visualization is one of the most important factors that increase the risk of intraoperative complications such as inadvertent injury to major vessels and nerves, and incomplete surgery. This article provide a logical approach to improving the surgical field, minimizing risk of inadvertent vascular injury, and managing intraoperative bleeding. PMID:27267017

  3. Endoscopic Ganglionectomy of the Elbow

    PubMed Central

    Lui, Tun Hing

    2015-01-01

    Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning. PMID:26870641

  4. Endoscopic Ganglionectomy of the Elbow.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning. PMID:26870641

  5. Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique

    PubMed Central

    Laddha, Abhishek; Ganpule, Arvind; Mishra, Sahshikant; Sabnis, Ravindra; Desai, Mahesh

    2016-01-01

    Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically. PMID:27279408

  6. Retrograde intra-vesical reconstructive surgery (RIVRS): A novel technique.

    PubMed

    Laddha, Abhishek; Ganpule, Arvind; Mishra, Sahshikant; Sabnis, Ravindra; Desai, Mahesh

    2016-01-01

    Management of distal ureter by en block resection during radical nephrectomy for upper urinary tract transitional cell carcinoma (TCC) is considered as standard of care. In this report, we describe our technique for management of lower ureter which utilizes both the endoscopic and laparoscopic approach. The nephrectomy including the dissection of the lower ureter was completed laproscopically. The ureteral orifice was scored using a hook passed through a 24 Fr nephroscope and secured .Transurethral suturing of the defect with SewRight SR5 device passed through the working channel of the 24 Fr nephroscope was done. Our report highlights the fact that management of lower ureter in TCC pelvis can be done endoscopically/laproscopically without compromising the oncological principles. Our novel technique demonstrates feasibility of intra mural resection of the ureter and primary closure of the bladder endoscopically. PMID:27279408

  7. Pancreatic Pseudocysts: Advances in Endoscopic Management.

    PubMed

    Ge, Phillip S; Weizmann, Mikhayla; Watson, Rabindra R

    2016-03-01

    Endoscopic drainage is the first-line therapy in the management of pancreatic pseudocysts. Before endoscopic drainage, clinicians should exclude the presence of pancreatic cystic neoplasms and avoid drainage of immature peripancreatic fluid collections or pseudoaneurysms. The indication for endoscopic drainage is not dependent on absolute cyst size alone, but on the presence of attributable signs or symptoms. Endoscopic management should be performed as part of a multidisciplinary approach in close cooperation with surgeons and interventional radiologists. Drainage may be performed either via a transpapillary approach or a transmural approach; additionally, endoscopic necrosectomy may be performed for patients with walled-off necrosis. PMID:26895678

  8. Endoscope Reprocessing: Update on Controversial Issues

    PubMed Central

    Choi, Hyun Ho

    2015-01-01

    Several issues concerning endoscope reprocessing remain unresolved based on currently available data. Thus, further studies are required to confirm standard practices including safe endoscope shelf life, proper frequency of replacement of some accessories including water bottles and connecting tubes, and microbiological surveillance testing of endoscopes after reprocessing. The efficacy and cost-effectiveness of newer technology that allows automated cleaning and disinfection is one such controversial issue. In addition, there are no guidelines on whether delayed reprocessing and extended soaking may harm endoscope integrity or increase the bioburden on the external or internal device surfaces. In this review, we discuss the unresolved and controversial issues regarding endoscope reprocessing. PMID:26473115

  9. Effects of chitin nano-whiskers on the gelatinization and retrogradation of maize and potato starches.

    PubMed

    Ji, Na; Liu, Chengzhen; Zhang, Shuangling; Yu, Jing; Xiong, Liu; Sun, Qingjie

    2017-01-01

    Starch is very prone to retrogradation after gelatinization. Inhibition of starch retrogradation has been an important factor in improving the quality of food. For the first time, we investigated the effect of nano-materials, represented by chitin nano-whiskers (CNWs), on the short- and long-term retrogradation of maize and potato starches. Rapid Visco-Analyser results showed that the addition of CNWs significantly decreased the setback values of maize and potato starches, which suggested that CNWs could retard the short-term retrogradation of starch. Differential scanning calorimetry and X-ray diffraction results showed that the percentage of retrogradation of maize and potato starches significantly decreased (P<0.05), suggesting the inhibition of long-term retrogradation. The CNWs could be used as a new inhibitor of starch retrogradation to develop starch-based food with longer shelf life. PMID:27507508

  10. Endoscopic treatment of duodenal fistula after incomplete closure of ERCP-related duodenal perforation

    PubMed Central

    Yu, Dong Wook; Hong, Man Yong; Hong, Seung Goun

    2014-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) is an important diagnostic and therapeutic modality for various pancreatic and biliary diseases. The most common ERCP-induced complication is pancreatitis, whereas hemorrhage, cholangitis, and perforation occur less frequently. Early recognition and prompt treatment of these complications may minimize the morbidity and mortality. One of the most serious complications is perforation. Although the incidence of duodenal perforation after ERCP has decreased to < 1.0%, severe cases still require prolonged hospitalization and urgent surgical intervention, potentially leading to permanent disability or mortality. Surgery remains the mainstay treatment for perforations of the luminal organs of the gastrointestinal tract. However, evidence from case reports and case series support a beneficial role of endoscopic clipping in the closure of these defects. Duodenal fistulas are usually a result of sphincterotomies, perforated duodenal ulcers, or gastrectomy. Other causative factors include Crohn’s disease, trauma, pancreatitis, and cancer. The majority of duodenal fistulas heal with nonoperative management. Those that fail to heal are best treated with gastrojejunostomy. Recently proposed endoscopic approaches for managing gastrointestinal leaks caused by fistulas include fibrin glue injection and positioning of endoclips. Our patient developed a secondary persistent duodenal fistula as a result of previous incomplete closure of duodenal perforation with hemoclips and an endoloop. The fistula was successfully repaired by additional clipping and fibrin glue injection. PMID:24932379

  11. Development of a Swine Benign Biliary Stricture Model Using Endoscopic Biliary Radiofrequency Ablation.

    PubMed

    Park, Jin Seok; Jeong, Seok; Kim, Joon Mee; Park, Sang Soon; Lee, Don Haeng

    2016-09-01

    The large animal model with benign biliary stricture (BBS) is essential to undergo experiment on developing new devices and endoscopic treatment. This study conducted to establish a clinically relevant porcine BBS model by means of endobiliary radiofrequency ablation (RFA). Endoscopic retrograde cholangiography (ERC) was performed on 12 swine. The animals were allocated to three groups (60, 80, and 100 W) according to the electrical power level of RFA electrode. Endobiliary RFA was applied to the common bile duct for 60 seconds using an RFA catheter that was endoscopically inserted. ERC was repeated two and four weeks, respectively, after the RFA to identify BBS. After the strictures were identified, histologic evaluations were performed. On the follow-up ERC two weeks after the procedure, a segmental bile duct stricture was observed in all animals. On microscopic examination, severe periductal fibrosis and luminal obliteration with transmural inflammation were demonstrated. Bile duct perforations occurred in two pigs (100 W, n = 1; 80 W, n = 1) but there were no major complications in the 60 W group. The application of endobiliary RFA with 60 W electrical power resulted in a safe and reproducible swine model of BBS. PMID:27510388

  12. New technique for retrograde cerebral perfusion during arch aneurysm repair.

    PubMed

    Bartoccioni, S; Lanzillo, G; deJong, A A; Fiaschini, P; Martinelli, G; Fedeli, C; Di Lazarro, D; Mercati, U

    1995-09-01

    Many techniques are used to reduce brain damage during surgery for dissecting aneurysms of the ascending aorta and arch. Recently, new techniques of protection were proposed, consistent with hypothermic circulatory arrest in association with retrograde cerebral perfusion via superior vena cava. We propose a simple, time-saving method, which does not require any manipulation of the heart. We use a multilumen cannula for cardioplegia (D 860-DIDECO FUNDARO') with pressure transducer. This cannula is inserted in superior vena cava by means of a simple purse-string, and linked to the arterial line with a "Y" derivation, allowing retrograde perfusion of the brain and monitoring the perfusion pressure at every moment. The superior vena cava placed downstream from the cannula is closed by a small vascular clamp, to avoid blood reflux in the right atrium. This method is time- and money-saving, is readily available, and can be prepared whenever necessary, also in the middle of the surgical procedure. PMID:7488786

  13. Learning the Languages of the Chloroplast: Retrograde Signaling and Beyond.

    PubMed

    Chan, Kai Xun; Phua, Su Yin; Crisp, Peter; McQuinn, Ryan; Pogson, Barry J

    2016-04-29

    The chloroplast can act as an environmental sensor, communicating with the cell during biogenesis and operation to change the expression of thousands of proteins. This process, termed retrograde signaling, regulates expression in response to developmental cues and stresses that affect photosynthesis and yield. Recent advances have identified many signals and pathways-including carotenoid derivatives, isoprenes, phosphoadenosines, tetrapyrroles, and heme, together with reactive oxygen species and proteins-that build a communication network to regulate gene expression, RNA turnover, and splicing. However, retrograde signaling pathways have been viewed largely as a means of bilateral communication between organelles and nuclei, ignoring their potential to interact with hormone signaling and the cell as a whole to regulate plant form and function. Here, we discuss new findings on the processes by which organelle communication is initiated, transmitted, and perceived, not only to regulate chloroplastic processes but also to intersect with cellular signaling and alter physiological responses. PMID:26735063

  14. Photosynthetic light reactions: integral to chloroplast retrograde signalling.

    PubMed

    Gollan, Peter J; Tikkanen, Mikko; Aro, Eva-Mari

    2015-10-01

    Chloroplast retrograde signalling is ultimately dependent on the function of the photosynthetic light reactions and not only guides the acclimation of the photosynthetic apparatus to changing environmental and metabolic cues, but has a much wider influence on the growth and development of plants. New information generated during the past few years about regulation of photosynthetic light reactions and identification of the underlying regulatory proteins has paved the way towards better understanding of the signalling molecules produced in chloroplasts upon changes in the environment. Likewise, the availability of various mutants lacking regulatory functions has made it possible to address the role of excitation energy distribution and electron flow in the thylakoid membrane in inducing the retrograde signals from chloroplasts to the nucleus. Such signalling molecules also induce and interact with hormonal signalling cascades to provide comprehensive information from chloroplasts to the nucleus. PMID:26318477

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

    PubMed

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

    2012-09-01

    Complete staghorn calculi are typically managed with percutaneous nephrolithotomy (PCNL). However, dilating nephrostomy and inserting a nephro access sheath can be difficult to perform without hydronephrosis. We reported the procedure of ureteroscopy-assisted retrograde nephrostomy (UARN) during PCNL. UARN is effective without dilating the renal collecting system in cases of complete staghorn calculi. A 63-year old female with a left complete staghorn renal calculus was referred to our hospital. Under general and epidural anesthesia, the patient was placed in a modified-Valdivia position. A flexible ureteroscope was inserted and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible ureteroscope. The puncture wire was forwarded along the route from the renal pelvis to the exit skin. Calculus fragmentation was done using a pneumatic lithotripter and the Ho: YAG laser. UARN during PCNL was effective for the treatment of a complete staghorn calculus. PMID:24917723

  16. Subversion of Retrograde Trafficking by Translocated Pathogen Effectors.

    PubMed

    Personnic, Nicolas; Bärlocher, Kevin; Finsel, Ivo; Hilbi, Hubert

    2016-06-01

    Intracellular bacterial pathogens subvert the endocytic bactericidal pathway to form specific replication-permissive compartments termed pathogen vacuoles or inclusions. To this end, the pathogens employ type III or type IV secretion systems, which translocate dozens, if not hundreds, of different effector proteins into their host cells, where they manipulate vesicle trafficking and signaling pathways in favor of the intruders. While the distinct cocktail of effectors defines the specific processes by which a pathogen vacuole is formed, the different pathogens commonly target certain vesicle trafficking routes, including the endocytic or secretory pathway. Recently, the retrograde transport pathway from endosomal compartments to the trans-Golgi network emerged as an important route affecting pathogen vacuole formation. Here, we review current insight into the host cell's retrograde trafficking pathway and how vacuolar pathogens of the genera Legionella, Coxiella, Salmonella, Chlamydia, and Simkania employ mechanistically distinct strategies to subvert this pathway, thus promoting intracellular survival and replication. PMID:26924068

  17. Sealing ability of five different retrograde filling materials.

    PubMed

    Gerhards, F; Wagner, W

    1996-09-01

    The sealing ability of Amalgam, Harvard-Cement, Diaket, gold-leaf, and Ketac-Endo as retrofilling materials was investigated. Paper cones were fixed with Harvard-Cement in the instrumented roots of 100 extracted human incisors. Apicectomy was performed and a 2-mm-deep retrograde cavity was prepared. Teeth were assigned to five groups (n = 20); each group received a different filling material. Surfaces of the roots were isolated with nail polish. Teeth, were stored in 1% methylene blue dye for 72 h. Roots were sectioned, and the depth of dye penetration was evaluated through a stereomicroscope. Retrofills with Ketac-Endo showed significantly less leakage compared with amalgam. There was no significant difference between the amalgam and Diaket groups. The sealing ability of Harvard-Cement and gold foil was lower than amalgam. It was concluded that retrograde fillings with Ketac-Endo or Diaket can be considered as alternatives for amalgam. PMID:9198426

  18. Endoscopic thyroidectomy: the transoral approach

    PubMed Central

    Hellinger, Achim; Kaminski, Cornelia; Benhidjeb, Tahar

    2016-01-01

    Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques—so called hybrid techniques—might be useful for our patients. PMID:27294042

  19. Transnasal Endoscopic Eustachian Tube Surgery.

    PubMed

    Dean, Marc; Lian, Timothy

    2016-10-01

    The purpose of this article is to give a contemporary review of transnasal endoscopic surgery for Eustachian tube disorders. The authors' perspective of the relevant anatomy, pathophysiology, and evaluation of Eustachian tube disorders as related to surgical intervention also is provided. PMID:27468637

  20. Endoscopic thyroidectomy: the transoral approach.

    PubMed

    Witzel, Kai; Hellinger, Achim; Kaminski, Cornelia; Benhidjeb, Tahar

    2016-06-01

    Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques-so called hybrid techniques-might be useful for our patients. PMID:27294042

  1. [Endoscopic management of urethral stricture].

    PubMed

    Rossi Neto, R; Tschirdewahn, S; Tschirderwahn, S; Rose, A; vom Dorp, F; Rübben, H

    2010-06-01

    Great progress has been seen in the treatment of urethral strictures since the first endoscopic urethrotomy was performed in 1893 by Felix Martin Oberländer in Dresden, Germany. With the introduction of endoscopic laser therapy and the variety of urethral reconstruction methods other ways to treat this important urologic entity became available. Despite this progress, urethrotomy still represents the preferred treatment concept for primary, short and bulbar urethral strictures. In this study we performed a 2-year retrospective analysis of 20 patients undergoing primary endoscopic urethrotomy by single bulbar or penile narrowing. A high incidence of recurrence was seen in 70% of the patients. Nevertheless, direct vision urethrotomy represented a safe and effective transitory method to treat these patients. Moreover, 80% of the patients preferred, in cases of recurrence, a repeated urethrotomy as the treatment of choice. Although the long-term results evidence high relapse rates after the first and second procedures, there have been no sufficient data in the literature which support the use of other methods. Furthermore, primary endoscopic management of urethral strictures remains a simple, safe, and cost-effective procedure that should be indicated before more invasive approaches are taken to provide relief to these patients from this limiting problem. PMID:20544332

  2. Endoscopic treatment of orbital tumors

    PubMed Central

    Signorelli, Francesco; Anile, Carmelo; Rigante, Mario; Paludetti, Gaetano; Pompucci, Angelo; Mangiola, Annunziato

    2015-01-01

    Different orbital and transcranial approaches are performed in order to manage orbital tumors, depending on the location and size of the lesion within the orbit. These approaches provide a satisfactory view of the superior and lateral aspects of the orbit and the optic canal but involve risks associated with their invasiveness because they require significant displacement of orbital structures. In addition, external approaches to intraconal lesions may also require deinsertion of extraocular muscles, with subsequent impact on extraocular mobility. Recently, minimally invasive techniques have been proposed as valid alternative to external approaches for selected orbital lesions. Among them, transnasal endoscopic approaches, “pure” or combined with external approaches, have been reported, especially for intraconal lesions located inferiorly and medially to the optic nerve. The avoidance of muscle detachment and the shortness of the surgical intraorbital trajectory makes endoscopic approach less invasive, thus minimizing tissue damage. Endoscopic surgery decreases the recovery time and improves the cosmetic outcome not requiring skin incisions. The purpose of this study is to review and discuss the current surgical techniques for orbital tumors removal, focusing on endoscopic approaches to the orbit and outlining the key anatomic principles to follow for safe tumor resection. PMID:25789299

  3. Wide FOV wedge prism endoscope.

    PubMed

    Kim, Keri; Kim, Daeyoung; Matsumiya, Kiyoshi; Kobayashi, Etsuko; Dohi, Takeyoshi

    2005-01-01

    We.. have developed a novel robotic endoscope system. It can be used to observe a wide field of view without moving or bending the whole endoscope system. .. It consists of a rigid endoscope and two wedge prisms at the distal tip. Rotating each wedge prism respectively, we can change the direction of view. Accordingly it becomes possible to observe a wide field of view even in a small space, and suited to clinical uses because it does not damage body tissues or internal organs. .. Wedge prisms are designed to avoid vignetting which is caused by the refraction or the reflection at prisms. The endoscope has 10mm in diameter, and the drive unit is simply separable for the sterilization. In addition, since it has a simple and small drive unit, it does not obstruct surgeon or other surgery robots. The maximum movement of local field of view is 19degrees, and global field of view is 93degrees. In the evaluation experiment, we conformed that both of the image quality and the performance are acceptable. PMID:17281566

  4. Stereo Imaging Miniature Endoscope

    NASA Technical Reports Server (NTRS)

    Bae, Youngsam; Manohara, Harish; White, Victor; Shcheglov, Kirill V.; Shahinian, Hrayr

    2011-01-01

    Stereo imaging requires two different perspectives of the same object and, traditionally, a pair of side-by-side cameras would be used but are not feasible for something as tiny as a less than 4-mm-diameter endoscope that could be used for minimally invasive surgeries or geoexploration through tiny fissures or bores. The proposed solution here is to employ a single lens, and a pair of conjugated, multiple-bandpass filters (CMBFs) to separate stereo images. When a CMBF is placed in front of each of the stereo channels, only one wavelength of the visible spectrum that falls within the passbands of the CMBF is transmitted through at a time when illuminated. Because the passbands are conjugated, only one of the two channels will see a particular wavelength. These time-multiplexed images are then mixed and reconstructed to display as stereo images. The basic principle of stereo imaging involves an object that is illuminated at specific wavelengths, and a range of illumination wavelengths is time multiplexed. The light reflected from the object selectively passes through one of the two CMBFs integrated with two pupils separated by a baseline distance, and is focused onto the imaging plane through an objective lens. The passband range of CMBFs and the illumination wavelengths are synchronized such that each of the CMBFs allows transmission of only the alternate illumination wavelength bands. And the transmission bandwidths of CMBFs are complementary to each other, so that when one transmits, the other one blocks. This can be clearly understood if the wavelength bands are divided broadly into red, green, and blue, then the illumination wavelengths contain two bands in red (R1, R2), two bands in green (G1, G2), and two bands in blue (B1, B2). Therefore, when the objective is illuminated by R1, the reflected light enters through only the left-CMBF as the R1 band corresponds to the transmission window of the left CMBF at the left pupil. This is blocked by the right CMBF. The

  5. Retrograde approach for closure of ruptured sinus of Valsalva.

    PubMed

    Jayaranganath, M; Subramanian, Anand; Manjunath, Cholenahally Nanjappa

    2010-07-01

    Though ruptured sinuses of Valsalva have been traditionally managed surgically, they are amenable to transcatheter closure. Various devices have been used for closure of these defects. We describe a novel technique of closure of a ruptured right sinus of Valsalva into the right ventricular outflow tract. A muscular ventricular septal defect occluder was deployed retrogradely, without resorting to the usual antegrade technique involving formation of an arteriovenous loop. PMID:20603510

  6. Formation Flying in Earth, Libration, and Distant Retrograde Orbits

    NASA Technical Reports Server (NTRS)

    Folta, David C.

    2004-01-01

    This slide presentation examines the current and future state of formation flying, LEO formations, control strategies for flight in the vicinity of the libration points, and distant retrograde orbit formations. This discussion of LEO formations includes background on perturbation theory/accelerations and LEO formation flying. The discussion of strategies for formation flight in the vicinity of the libration points includes libration missions and natural and controlled libration orbit formations. A reference list is included.

  7. Transit Timing Variations for Inclined and Retrograde Exoplanetary Systems

    NASA Astrophysics Data System (ADS)

    Payne, Matthew J.; Ford, Eric B.; Veras, Dimitri

    2010-03-01

    We perform numerical calculations of the expected transit timing variations (TTVs) induced on a hot-Jupiter by an Earth-mass perturber. Motivated by the recent discoveries of retrograde transiting planets, we concentrate on an investigation of the effect of varying relative planetary inclinations, up to and including completely retrograde systems. We find that planets in low-order (e.g., 2:1) mean-motion resonances (MMRs) retain approximately constant TTV amplitudes for 0° < i < 170°, only reducing in amplitude for i>170°. Systems in higher order MMRs (e.g., 5:1) increase in TTV amplitude as inclinations increase toward 45°, becoming approximately constant for 45° < i < 135°, and then declining for i>135°. Planets away from resonance slowly decrease in TTV amplitude as inclinations increase from 0° to 180°, whereas planets adjacent to resonances can exhibit a huge range of variability in TTV amplitude as a function of both eccentricity and inclination. For highly retrograde systems (135° < i <= 180°), TTV signals will be undetectable across almost the entirety of parameter space, with the exceptions occurring when the perturber has high eccentricity or is very close to an MMR. This high inclination decrease in TTV amplitude (on and away from resonance) is important for the analysis of the known retrograde and multi-planet transiting systems, as inclination effects need to be considered if TTVs are to be used to exclude the presence of any putative planetary companions: absence of evidence is not evidence of absence.

  8. Activity-Dependent Regulation of Synapses by Retrograde Messengers

    PubMed Central

    Regehr, Wade G.; Carey, Megan R.; Best, Aaron R.

    2011-01-01

    Summary Throughout the brain postsynaptic neurons release substances from their cell bodies and dendrites that regulate the strength of the synapses they receive. Diverse chemical messengers have been implicated in retrograde signaling from postsynaptic neurons to presynaptic boutons. Here we provide an overview of the signaling systems that lead to rapid changes in synaptic strength. We consider the capabilities, specializations and physiological roles of each type of signaling system. PMID:19640475

  9. Vascular Plug Assisted Retrograde Transvenous Obliteration (PARTO) for Gastric Varix Bleeding Patients in the Emergent Clinical Setting

    PubMed Central

    Yang, Heechul; Lee, Chun Kyon; Kim, Gun Bea

    2016-01-01

    Purpose To evaluate the technical feasibility and safety of vascular plug assisted retrograde transvenous obliteration (PARTO) for bleeding gastric varix performed in the emergent clinical setting and describe the mid-term clinical results. Materials and Methods From April 2012 to January 2015, emergent PARTO was tried in total 9 patients presented with active gastric varix bleeding. After initial insufficient or failure of endoscopic approach, they underwent PARTO in the emergent clinical setting. Gelatin sponge embolization of both gastrorenal (GR) shunt and gastric varix was performed after retrograde transvenous placement of a vascular plug in GR shunt. Coil assisted RTO (CARTO) was performed in one patient who had challenging GR shunt anatomy for vascular plug placement. Additional embolic materials, such as microcoils and NBCA glue-lipiodol mixture, were required in three patients to enhance complete occlusion of GR shunt or obliteration of competitive collateral vessels. Clinical success was defined as no variceal rebleeding and disappearance of gastric varix. Results All technical and clinical success–i.e., complete GR shunt occlusion and offending gastric varix embolization with immediate bleeding control–was achieved in all 9 patients. There was no procedure-related complication. All cases showed successful clinical outcome during mean follow up of 17 months (12–32 months), evidenced by imaging studies, endoscopy and clinical data. In 4 patients, mild worsening of esophageal varices or transient ascites was noted as portal hypertensive related change. Conclusion Emergent PARTO is technically feasible and safe, with acceptable mid-term clinical results, in treating active gastric varix bleeding. PMID:27189294

  10. Osteochondritis Dissecans Involving the Trochlear Groove Treated With Retrograde Drilling

    PubMed Central

    Kaji, Yoshio; Nakamura, Osamu; Yamaguchi, Konosuke; Yamamoto, Tetsuji

    2015-01-01

    Abstract Osteochondritis dissecans (OCD) occurs frequently in the humeral capitellum of the upper extremity, whereas OCD involving the trochlear groove (trochlear groove OCD) is rarely reported. A standard treatment for trochlear groove OCD has therefore not been determined, although several methods have been tried. The case of a 14-year-old male gymnast with bilateral trochlear groove OCD is presented. Retrograde drilling from the lateral condyle of the humerus was applied for the OCD lesion of the left elbow, since it was larger in size than that in the right elbow and was symptomatic. Conversely, since the right lesion was small and asymptomatic, it was managed conservatively. After treatment, consolidation of the OCD lesions was observed in both elbows. However, the time to healing was shorter in the left elbow treated surgically than in the right elbow managed conservatively. In conclusion, retrograde drilling is a very simple and minimally invasive treatment. This case suggests that retrograde drilling for trochlear groove OCD may be a useful procedure that may accelerate the healing process for OCD lesions. PMID:26356703

  11. Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions

    PubMed Central

    Vila, Juan J; Kutz, Marcos; Goñi, Silvia; Ostiz, Miriam; Amorena, Edurne; Prieto, Carlos; Rodriguez, Cristina; Fernández-Urien, Ignacio; Jiménez, Francisco J

    2011-01-01

    AIM: To discuss the feasibility of single session endoscopic ultrasonography (EUS) to discuss and endoscopic retrograde cholangiopancreatography (ERCP) execution. METHODS: Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session (Group I) versus performing each procedure in two different sessions (Group II) was made. The following variables were evaluated: epidemiological variables, American Society of Anesthesiologists Physical Status Classification (ASA) level, procedural time, propofol dose, anesthetic complications, endoscopic complications and diagnostic yield, and therapeutic procedures on both groups. T-student, Chi-Square and Fisher test were used for comparison. RESULTS: We included 39 patients in Group I (mean age: 69.85 ± 9.25; 27 men) and 46 in Group II (mean age: 67.46 ± 12.57; 25 men). Procedural time did not differ significantly between both groups (Group Ivs Group II: 93 ± 32.78 vs 98.98 ± 38.17; P >0.05) but the dose of propofol differed (Group I vs Group II: 322.28 ± 250.54 mg vs 516.96 ± 289.06 mg; P = 0.001). Three patients had normal findings on both explorations. Three anesthetic complications [O2 desaturation (2), broncoaspiration (1)] and 9 endoscopic complications [pancreatitis (6), bleeding (1), perforation (1), cholangitis (1)] occurred without significant differences between both groups (P > 0.05). We did not find any significant difference regarding age, sex, ASA scale level, diagnostic yield or therapeutic maneuvers between both groups. CONCLUSION: The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield, does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session. PMID:21455343

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

    PubMed

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

    2014-09-01

    Native rice starch (NRS, amylose/28.9%) was gelatinized by improved extrusion cooking technology (IECT) and retrograded (RRS) after low temperature storage (4 °C). The retrogradation behaviour of RRS was changed to low retrogradation percentage and low retrogradation rate. The retrogradation resulted in a high compact morphology. The melt enthalpy change and percentage of retrogradation of RRS was 3.68 J/g and 37.7%, respectively, compared to those of NRS (9.75 J/g, 100%). The retrogradation percentage for RRS was low during storage as shown as a low retrogradation rate (0.21 d(-1)) and a high Avrami exponent (0.89). The pattern of rice starch changed from A-type to amorphous and B-type. Both the relative crystallinity of RRS (12.7%) by the X-ray diffractograms and the ratio of the band height (0.63) in the FTIR spectra were low. The analysis of retrogradation structure and short-range molecular order further confirmed the retrogradation behaviour of rice starch after IECT treatment. PMID:24731339

  13. Endoscopic duodenal perforation: surgical strategies in a regional centre

    PubMed Central

    2014-01-01

    Background Duodenal perforation is an uncommon complication of endoscopic retrograde cholangio-pancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy. Most are minor perforations that settle with conservative management. A few perforations however result in life-threatening retroperitoneal necrosis and require surgical intervention. There is a relative paucity of references specifically describing the surgical interventions required for this eventuality. Methods Five cases of iatrogenic duodenal perforation were ascertained between 2002 and 2007 at Cairns Base Hospital. Clinical features were analyzed and compared, with reference to a review of ERCP at that institution for the years 2005/2006. Results One patient recovered with conservative management. Of the other four, one died after initial laparotomy. The other three survived, undergoing multiple procedures and long inpatient stays. Conclusions Iatrogenic duodenal perforation with retroperitoneal necrosis is an uncommon complication of endoscopy, but when it does occur it is potentially life-threatening. Early recognition may lead to a better outcome through earlier intervention, although a protracted course with multiple procedures should be anticipated. A number of surgical techniques may need to be employed according to the individual circumstances of the case. PMID:24461069

  14. Back to Basics: Flexible Endoscope Processing.

    PubMed

    Spruce, Lisa

    2016-05-01

    Flexible endoscopes are important tools in patient care, yet recent outbreaks of infections in patients who have undergone endoscopic procedures have increased awareness of how the complex design of these instruments makes them difficult to clean. This Back to Basics article focuses on flexible endoscope processing and provides sterile processing, endoscopy, and perioperative team members with strategies for successful processing of these instruments. PMID:27129751

  15. Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction.

    PubMed

    Michels, Frederick; Cordier, Guillaume; Guillo, Stéphane; Stockmans, Filip

    2016-09-01

    Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique. PMID:27524711

  16. Outcomes of endoscopic transsphenoidal pituitary surgery.

    PubMed

    Dallapiazza, Robert F; Jane, John A

    2015-03-01

    Since the 1990s, endoscopic transsphenoidal surgery for pituitary adenomas has increased in popularity. Outcomes of endoscopic surgery for clinically secretory adenomas are favorable, and results for nonfunctional tumors reveal high rates of complete resection, improvements in vision, and low rates of complications. This article discusses some of the recent studies reporting outcomes from endoscopic series for Cushing disease, acromegaly, prolactin-secreting tumors, and nonfunctioning macroadenomas. PMID:25732647

  17. Coupling of Retrograde Flow to Force Production During Malaria Parasite Migration.

    PubMed

    Quadt, Katharina A; Streichfuss, Martin; Moreau, Catherine A; Spatz, Joachim P; Frischknecht, Friedrich

    2016-02-23

    Migration of malaria parasites is powered by a myosin motor that moves actin filaments, which in turn link to adhesive proteins spanning the plasma membrane. The retrograde flow of these adhesins appears to be coupled to forward locomotion. However, the contact dynamics between the parasite and the substrate as well as the generation of forces are complex and their relation to retrograde flow is unclear. Using optical tweezers we found retrograde flow rates up to 15 μm/s contrasting with parasite average speeds of 1-2 μm/s. We found that a surface protein, TLP, functions in reducing retrograde flow for the buildup of adhesive force and that actin dynamics appear optimized for the generation of force but not for maximizing the speed of retrograde flow. These data uncover that TLP acts by modulating actin dynamics or actin filament organization and couples retrograde flow to force production in malaria parasites. PMID:26792112

  18. Advanced virtual endoscopic pituitary surgery.

    PubMed

    Neubauer, André; Wolfsberger, Stefan; Forster, Marie-Thérèse; Mroz, Lukas; Wegenkittl, Rainer; Bühler, Katja

    2005-01-01

    Endoscopy has recently been introduced to endonasal transsphenoidal pituitary surgery as a minimally invasive procedure for the removal of various kinds of pituitary tumors. To reduce morbidity and mortality with this new technique, the surgeon must be well-trained and well-prepared. Virtual endoscopy can be beneficial as a tool for training, preoperative planning, and intraoperative support. This paper introduces STEPS, a virtual endoscopy system designed to aid surgeons in getting acquainted with the endoscopic view of the anatomy, the handling of instruments, the transsphenoidal approach, and challenges associated with the procedure. STEPS also assists experienced surgeons in planning a real endoscopic intervention by getting familiar with the individual patient anatomy, identifying landmarks, planning the approach, and deciding upon the ideal target position of the actual surgical activity. The application provides interactive visualization, navigation, and perception aids and the possibility of simulating the procedure, including haptic feedback and simulation of surgical instruments. PMID:16144247

  19. Endoscopic subsurface imaging in tissues

    SciTech Connect

    Demos, S G; Staggs, M; Radousky, H B

    2001-02-12

    The objective of this work is to develop endoscopic subsurface optical imaging technology that will be able to image different tissue components located underneath the surface of the tissue at an imaging depth of up to 1 centimeter. This effort is based on the utilization of existing technology and components developed for medical endoscopes with the incorporation of the appropriate modifications to implement the spectral and polarization difference imaging technique. This subsurface imaging technique employs polarization and spectral light discrimination in combination with image processing to remove a large portion of the image information from the outer layers of the tissue which leads to enhancement of the contrast and image quality of subsurface tissue structures.

  20. Endoscopic laser therapy in gastroenterology.

    PubMed Central

    Pritikin, J; Weinman, D; Harmatz, A; Young, H

    1992-01-01

    Endoscopic laser therapy has become an important and widely used tool in gastroenterology. It has become important for outpatient palliative therapy for ablating obstructing gastrointestinal neoplasms. This method has often circumvented the need for major palliative surgical resections. Caution must be applied to laser therapy for potentially curable malignant neoplasms because, with vaporization of the target tissue, no tissue specimen is available to assure that local or invasive residual carcinoma is excluded. Therefore, in good surgical candidates, surgical resection of potentially curable cancers is always recommended. In the future, however, the combination of refined endoscopic ultrasonography and laser fluorescence techniques may lead to earlier detection, more precise localization, and even curative ablation of gastrointestinal malignancy. Images PMID:1413743

  1. Robotically Assisted Endoscopic Ovarian Transposition

    PubMed Central

    Wedergren, June S.; Carlson, Mark A.

    2003-01-01

    Background: Ovarian transposition is the anatomical relocation of the ovaries from the pelvis to the abdomen. Transposition is beneficial in women who are to undergo pelvic radiation, because it allows maintenance of ovarian function and preservation of assisted reproductive capacity. Methods: The da Vinci surgical system (Intuitive Surgical™, Mountainview, CA, USA) was used to perform an endoscopic ovarian transposition. The ovaries were mobilized on their respective infundibulopelvic ligaments and sutured to the ipsilateral pericolic gutters. Results: A series of laboratory sessions using the da Vinci system was completed at our institution's training facility. Surgical experience included cadaveric pelvic dissection and abdominopelvic procedures on anesthetized porcine models. Additional didactic and laboratory training, including a certification examination, was obtained from Intuitive Surgical, Inc. The first clinical case of robotically assisted endoscopic ovarian transposition was performed. Conclusions: Robotically assisted endoscopy was successfully used for ovarian transposition. PMID:12723000

  2. Endoscopic treatment for early gastric cancer.

    PubMed

    Min, Yang Won; Min, Byung-Hoon; Lee, Jun Haeng; Kim, Jae J

    2014-04-28

    Gastric cancer remains one of the most common causes of cancer death. However the proportion of early gastric cancer (EGC) at diagnosis is increasing. Endoscopic treatment for EGC is actively performed worldwide in cases meeting specific criteria. Endoscopic mucosal resection can treat EGC with comparable results to surgery for selected cases. Endoscopic submucosal dissection (ESD) increases the en bloc and complete resection rates and reduces the local recurrence rate. ESD has been performed with expanded indication and is expected to be more widely used in the treatment of EGC through the technological advances in the near future. This review will describe the techniques, indications and outcomes of endoscopic treatment for EGC. PMID:24782609

  3. Endoscopic full-thickness resection: Current status

    PubMed Central

    Schmidt, Arthur; Meier, Benjamin; Caca, Karel

    2015-01-01

    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. PMID:26309354

  4. Endoscopic full-thickness resection: Current status.

    PubMed

    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. PMID:26309354

  5. Endoscopic Anatomy of the Protympanum.

    PubMed

    Jufas, Nicholas; Marchioni, Daniele; Tarabichi, Muaaz; Patel, Nirmal

    2016-10-01

    The protympanum, a final common pathway between the tympanic cavity and external environment, is gaining relevance due to the ease and completeness of visualization with angled endoscopes. Two primary conformations are described, quadrangular and triangular, and new anatomic structures such as the protiniculum, subtensor recess, and protympanic spine are defined. Surgical relevance of the protympanum is described with respect to ventilation, cholesteatoma, cerebrospinal fluid leak, otic neuralgia, and surgical access to the eustachian tube. PMID:27565384

  6. Barrett's esophagus: endoscopic treatments II

    PubMed Central

    Greenwald, Bruce D.; Lightdale, Charles J.; Abrams, Julian A.; Horwhat, John D.; Chuttani, Ram; Komanduri, Srinadh; Upton, Melissa P.; Appelman, Henry D.; Shields, Helen M.; Shaheen, Nicholas J.; Sontag, Stephen J.

    2013-01-01

    The following on endoscopic treatments of Barrett's esophagus includes commentaries on animal experiments on cryotherapy; indications for cryotherapy, choice of dosimetry, number of sessions, and role in Barrett's esophagus and adenocarcinoma; recent technical developments of RFA technology and long-term effects; the comparative effects of diverse ablation procedures and the rate of recurrence following treatment; and the indications for treatment of dysplasia and the role of radiofrequency ablation. PMID:21950812

  7. Endoscopic treatment of esophageal achalasia

    PubMed Central

    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

  8. Possibilities of interventional endoscopic ultrasound

    PubMed Central

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-01-01

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other “interventional EUS” procedures. In this review, we have summarized the new possibilities offered by “interventional EUS”. PMID:22816010

  9. Endoscopic resection of sinonasal malignancies.

    PubMed

    Nicolai, Piero; Castelnuovo, Paolo; Bolzoni Villaret, Andrea

    2011-04-01

    Malignant tumors of the sinonasal tract are rare, accounting for only 1% of all malignancies. Although they are associated with substantial histological heterogeneity, surgery plays a key role in their management. This review addresses the evolution of current treatments in view of the introduction of endoscopic resection techniques. The absence of facial incisions and osteotomies, decreased hospitalization time, better control of bleeding, improved visualization of tumor borders, and reduced morbidity and mortality rate are the major advantages of endoscopic techniques in comparison to traditional external approaches. The major criticisms focus on oncologic results in view of the short/intermediate follow-up of large series, which have commonly grouped together several histologies that may be associated with different prognoses. Since prospective studies contrasting the results of endoscopic and craniofacial resections are difficult to carry out given the rarity of the disease together with ethical issues, the creation of a large database would favor the analysis of several variables related to the patient, tumor, and treatment on survival performed on a large number of patients. PMID:21243539

  10. Endoscopic treatment of esophageal achalasia.

    PubMed

    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. PMID:26839644

  11. Possibilities of interventional endoscopic ultrasound.

    PubMed

    Nishimura, Makoto; Togawa, Osamu; Matsukawa, Miho; Shono, Takashi; Ochiai, Yasutoshi; Nakao, Masamitsu; Ishikawa, Keiko; Arai, Shin; Kita, Hiroto

    2012-07-16

    Since endoscopic ultrasound (EUS) was developed in the 1990s, EUS has become widely accepted as an imaging tool. EUS is categorized into radial and linear in design. Radial endoscopes provide cross-sectional imaging of the mediastinum, gastrointestinal tract, liver, spleen, kidney, adrenal gland, and pancreas, which has highly accuracy in the T and N staging of esophageal, lung, gastric, rectal, and pancreatic cancer. Tumor staging is common indication of radial-EUS, and EUS-staging is predictive of surgical resectability. In contrast, linear array endoscope uses a side-viewing probe and has advantages in the ability to perform EUS-guides fine needle aspiration (EUS-FNA), which has been established for cytologic diagnosis. For example, EUS-FNA arrows accurate nodal staging of esophageal cancer before surgery, which provides more accurate assessment of nodes than radial-EUS imaging alone. EUS-FNA has been also commonly used for diagnose of pancreatic diseases because of the highly accuracy than US or computed tomography. EUS and EUS-FNA has been used not only for TNM staging and cytologic diagnosis of pancreatic cancer, but also for evaluation of chronic pancreatitis, pancreatic cystic lesions, and other pancreatic masses. More recently, EUS-FNA has developed into EUS-guided fine needle injection including EUS-guided celiac plexus neurolysis, celiac plexus block, and other "interventional EUS" procedures. In this review, we have summarized the new possibilities offered by "interventional EUS". PMID:22816010

  12. [ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY(ERCP): EXPERIENCE IN 902 PROCEDURES AT THE ENDOSCOPY DIGESTIVE CENTRE OF "ARZOBISPO LOAYZA" HOSPITAL

    PubMed

    Vargas Cardenas, Gloria; Astete Benavides, Magdalena

    1997-01-01

    On 1997, the Digestive Endoscopy Centre of "Arzobispo Loayza" Hospital was created with the cooperation of JICA (Japan International Cooperation Agency). 902 ERCP were regularly performed from 1985 to August 1997. 902 tests were reviewed and 831 cases were left after excluding 16 ampulloma cases, 15 cannulated or insufficient cases and 40 cases dealing only with pancreatic duct cannulation. The population is examined according to sex, age and diagnosis, establishing a relation among these three variables. Results showed that most of ERCP were made to women (3:1) with Choledocal Lithiasis (C.L.) and cholecistectomy antecedents, a greater frequency was observed in 56-65 year old women. In males, it was more frequent in people older than 65 years, they also had predominance of choledocal lithiasis, but malignant neoplasia of the biliary duct ranked in the third place. The highest incidence of C.L. with cholecistectomy antecedents suggests the performance of an appropriate evaluation of the biliary duct before surgery. PMID:12177716

  13. Hemodynamic changes and retrograde flow in LVAD failure.

    PubMed

    Giridharan, Guruprasad A; Koenig, Steven C; Soucy, Kevin G; Choi, Young; Pirbodaghi, Tohid; Bartoli, Carlo R; Monreal, Gretel; Sobieski, Michael A; Schumer, Erin; Cheng, Allen; Slaughter, Mark S

    2015-01-01

    In the event of left ventricular assist device (LVAD) failure, we hypothesized that rotary blood pumps will experience significant retrograde flow and induce adverse physiologic responses. Catastrophic LVAD failure was investigated in computer simulation with pulsatile, axial, and centrifugal LVAD, mock flow loop with pulsatile (PVAD) and centrifugal (ROTAFLOW), and healthy and chronic ischemic heart failure bovine models with pulsatile (PVAD), axial (HeartMate II), and centrifugal (HVAD) pumps. Simulated conditions were LVAD "off" with outflow graft clamped (baseline), LVAD "off" with outflow graft unclamped (LVAD failure), and LVAD "on" (5 L/min). Hemodynamics (aortic and ventricular blood pressures, LVAD flow, and left ventricular volume), echocardiography (cardiac volumes), and end-organ perfusion (regional blood flow microspheres) were measured and analyzed. Retrograde flow was observed with axial and centrifugal rotary pumps during LVAD failure in computer simulation (axial = -3.4 L/min, centrifugal = -2.8 L/min), mock circulation (pulsatile = -0.1 L/min, centrifugal = -2.7 L/min), healthy (pulsatile = -1.2 ± 0.3 L/min, axial = -2.2 ± 0.2 L/min, centrifugal = -1.9 ± 0.3 L/min), and ischemic heart failure (centrifugal = 2.2 ± 0.7 L/min) bovine models for all test conditions (p < 0.05). Differences between axial and centrifugal LVAD were statistically indiscernible. Retrograde flow increased ventricular end-systolic and end-diastolic volumes and workload, and decreased myocardial and end-organ perfusion during LVAD failure compared with baseline, LVAD support, and pulsatile LVAD failure. PMID:25635935

  14. Approximations of distant retrograde orbits for mission design

    NASA Technical Reports Server (NTRS)

    Hirani, Anil N.; Russell, Ryan P.

    2006-01-01

    Distant retrograde orbits (DROs) are stable periodic orbit solutions of the equations of motion in the circular restricted three body problem. Since no closed form expressions for DROs are known, we present methods for approximating a family of planar DROs for an arbitrary, fixed mass ratio. Furthermore we give methods for computing the first and second derivatives of the position and velocity with respect to the variables that parameterize the family. The approximation and derivative methods described allow a mission designer to target specific DROs or a range of DROs with no regard to phasing in contrast to the more limited case of targeting a six-state only.

  15. A chloroplast retrograde signal regulates nuclear alternative splicing

    PubMed Central

    Petrillo, Ezequiel; Herz, Micaela A. Godoy; Fuchs, Armin; Reifer, Dominik; Fuller, John; Yanovsky, Marcelo J.; Simpson, Craig; Brown, John W. S.; Barta, Andrea; Kalyna, Maria; Kornblihtt, Alberto R.

    2015-01-01

    Light is a source of energy and also a regulator of plant physiological adaptations. We show here that light/dark conditions affect alternative splicing of a subset of Arabidopsis genes preferentially encoding proteins involved in RNA processing. The effect requires functional chloroplasts and is also observed in roots when the communication with the photosynthetic tissues is not interrupted, suggesting that a signaling molecule travels through the plant. Using photosynthetic electron transfer inhibitors with different mechanisms of action we deduce that the reduced pool of plastoquinones initiates a chloroplast retrograde signaling that regulates nuclear alternative splicing and is necessary for proper plant responses to varying light conditions. PMID:24763593

  16. Endoscopic urethrotomy versus urethrotomy plus Nd-YAG laser in the treatment of urethral stricture.

    PubMed

    Vicente, J; Salvador, J; Caffaratti, J

    1990-01-01

    Between February 1987 and May 1988, 30 patients who presented with single, iatrogenic, annular strictures of the bulbar urethra were included in this prospective study. They were randomly divided into two groups; group 1: 15 patients who underwent direct-vision endoscopic urethrotomy (cold-knife incision at 12 o'clock) and group 2: 15 patients who underwent internal urethrotomy plus Nd-YAG laser. The results obtained were analyzed and compared at 1 and 2 years by clinical evaluation, uroflowmetry and retrograde-voiding urethrography. Group 1 obtained 80% good results at 1 year, falling to 60% at 2 years follow-up. Group 2 presented good results in 73.3% both at 1 and 2 years of follow-up. PMID:2261927

  17. Microbiological monitoring of endoscopes: 5-year review.

    PubMed

    Gillespie, Elizabeth E; Kotsanas, Despina; Stuart, Rhonda L

    2008-07-01

    Periodic microbiological monitoring of endoscopes is a recommendation of the Gastroenterological Society of Australia (GENSA). The aim of monitoring has been to provide quality assurance of the cleaning and disinfection of endoscopes; however, there is controversy regarding its frequency. This lack of consensus stimulated a review of the experience within our health service. At Southern Health, routine microbiological sampling has involved 4-weekly monitoring of bronchoscopes, duodenoscopes and automated flexible endoscope reprocessors (AFER), and 3-monthly monitoring of all other gastrointestinal endoscopes. Records of testing were reviewed from 1 January 2002 until 31 December 2006. A literature review was conducted, cost analysis performed and positive cultures investigated. There were 2374 screening tests performed during the 5-year period, including 287 AFER, 631 bronchoscopes for mycobacteria and 1456 endoscope bacterial screens. There were no positive results of the AFER or bronchoscopes for mycobacteria. Of the 1456 endoscopic bacterial samples, six were positive; however, retesting resulted in no growth. The overall cost of tests performed and cost in time for nursing staff to collect the samples was estimated at $AUD 100,400. Periodic monitoring of endoscopes is both time-consuming and costly. Our review demonstrates that AFER (Soluscope) perform well in cleaning endoscopes. Based on our 5-year experience, assurance of quality for endoscopic use could be achieved through process control as opposed to product control. Maintenance of endoscopes and AFER should be in accordance with the manufacturer's instructions and microbiological testing performed on commissioning, annually and following repair. Initial prompt manual leak testing and manual cleaning followed by mechanical leak testing, cleaning and disinfection should be the minimum standard in reprocessing of endoscopes. PMID:18086113

  18. Retrograde intrarenal surgery in Nepal: an early experience.

    PubMed

    Gyawali, P R; Luitel, B R; Luitel, B R

    2013-06-01

    With the advancement in technology and miniaturization of instruments, retrograde intrarenal surgery (RIRS) with flexible ureteroscope is gaining popularity. Flexible ureteroscope is introduced into renal collecting system through the urethra. Holmium YAG (Ho-YAG) Laser fiber of different sizes is introduced through the ureteroscope and renal stones are pulverized. Removal of renal stones less than 15 mm in size with RIRS has sharply reduced post operative morbidity. This is a Prospective study comprised of 58 RIRS performed from January 2013 to July 2013. Preoperative investigations like full blood count (FBC), renal function test (RFT), serological investigations, urine culture, intravenous urogram or CT-urogram, chest ray and electrocardiogram were done in all patients. Renal stones less than 15 mm in size were included for RIRS. Intra renal stones were treated with 7.5 Fr flexible ureteroscope (Flex - X2) using Holmium-YAG laser. Mean stone burden in our study was 10.5 +/- 3.3 mm. Out of 32 male patients, 29 (90.6%) required pre-stenting before RIRS and all 58 patients with successful dusting of stones in single sitting were discharged on next day. Retrograde Intrarenal Surgery is advanced and successful technique and a viable alternative to Extracorporeal Shock Wave Lithotripsy (ESWL) and Percutaneous Nephrolithotomy (PCNL) in the treatment of selected intrarenal stones with minimum morbidity. PMID:24696935

  19. Retrograde closed orbits in a rotating triaxial potential

    NASA Astrophysics Data System (ADS)

    Heisler, J.; Merritt, D.; Schwarzschild, M.

    1982-07-01

    Four closed periodic orbit sequences are determined numerically, and their stability is investigated by the standard Floquet method, for the case of a specific, triaxial rotating potential. The sequences comprise (1) stable anomalous orbits that are tipped to the long axis which they circle, so that they also circle the short rotation axis, (2) unstable, anomalous orbits circling the intermediate axis, otherwise behaving like (1), (3) stable, normal retrograde orbits lying in the equatorial plane, which become unstable against perpendicular perturbations in Binney's instability strip, and (4) Z-axis orbits lying on the rotation axis, which, although stable in their inner section, become unstable to perturbations parallel to the intermediate axis farther out, and to the long axis farther out still. The entire set contains one composite sequence which is stable over the entire energy range, consisting of the outer section of the normal retrograde orbits, the sequence of the anomalous orbits, and the inner section of the Z-axis orbits. It is suggested that the composite sequence may be relevant to the dynamics of gas masses captured by rotating triaxial galaxies.

  20. Quantitative radioactive analysis of microleakage of four different retrograde fillings.

    PubMed

    Danin, J; Linder, L; Sund, M L; Strömberg, T; Torstenson, B; Zetterqvist, L

    1992-07-01

    Sealing properties of four different retrograde filling materials were investigated in vitro. Radioactive isotopes were applied in the root canal, and leakage into an extraradicular fluid was measured at regular intervals. The method permitted repeated observation of the specimens over prolonged periods of time. Forty single-rooted human teeth were biomechanically instrumented and obturated using calcium-hydroxide paste. Following obturation, an apicectomy was performed and retrograde cavities were filled with four different materials: group 1, non gamma 2 amalgam (Amalcap); group 2, glass ionomer cement (Ketac Silver); group 3, calcium-hydroxide-based root canal sealer (Sealapex); group 4, composite resin (Palfique Light-S). After removal of the calcium hydroxide, the teeth were immersed in a fluid. An isotope solution was then placed in the root canals. Samples were taken from the fluid at 0, 3, 7, 28, 56, 105, 210, 285 and 376 days to determine the radioactivity. It was found that Sealapex and Palfique Light-S showed significantly less leakage than amalgam and glass ionomer cement, which had the highest apical leakage. PMID:1399068

  1. Endoscopic-assisted infraorbital nerve release

    PubMed Central

    Sosin, Michael; De La Cruz, Carla; Christy, Michael R.

    2014-01-01

    Abstract Endoscopic-assisted techniques in plastic and craniofacial surgeries are limited. We present a patient with infraorbital nerve entrapment following traumatic facial injury that failed conservative management. Compression of the nerve was treated with an endoscopic-assisted nerve release of the surrounding soft tissue with a circumferential foraminal osteotomy.

  2. Endoscopic techniques in aesthetic plastic surgery.

    PubMed

    McCain, L A; Jones, G

    1995-01-01

    There has been an explosive interest in endoscopic techniques by plastic surgeons over the past two years. Procedures such as facial rejuvenation, breast augmentation and abdominoplasty are being performed with endoscopic assistance. Endoscopic operations require a complex setup with components such as video camera, light sources, cables and hard instruments. The Hopkins Rod Lens system consists of optical fibers for illumination, an objective lens, an image retrieval system, a series of rods and lenses, and an eyepiece for image collection. Good illumination of the body cavity is essential for endoscopic procedures. Placement of the video camera on the eyepiece of the endoscope gives a clear, brightly illuminated large image on the monitor. The video monitor provides the surgical team with the endoscopic image. It is important to become familiar with the equipment before actually doing cases. Several options exist for staff education. In the operating room the endoscopic cart needs to be positioned to allow a clear unrestricted view of the video monitor by the surgeon and the operating team. Fogging of the endoscope may be prevented during induction by using FREDD (a fog reduction/elimination device) or a warm bath. The camera needs to be white balanced. During the procedure, the nurse monitors the level of dissection and assesses for clogging of the suction. PMID:7568452

  3. Endoscopic approach for quadrigeminal cistern arachnoid cyst.

    PubMed

    Yu, Lei; Qi, Songtao; Peng, Yuping; Fan, Jun

    2016-08-01

    Objectives Quadrigeminal cistern arachnoid cysts (QCACs), which are usually asymptomatic and may be accidental findings during radiological evaluation, are rare, comprising 5-10% of all intracranial arachnoid cysts (ACs). We report a series of eight patients with QCACs treated with neuroendoscopic intervention and try to discuss the different endoscopic approaches according to the different types of QCACs. Materials and methods Between October 2007 and January 2013, eight patients affected by QCACs were endoscopically treated. All the endoscopic procedures were completed uneventfully (infratentorial approaches in four cases and supratentorial approaches in four cases), which included ventriculocystostomy in seven cases (lateral ventriculocystostomy in one case, third ventricle cystostomy in five cases and both in one case), endoscopic third ventriculostomy in three cases and cystocisternostomy in one case. Results Five patients achieved complete cure after the endoscopic procedure alone; nevertheless, in none of the patients did the cyst totally collapse following the endoscopic procedure during follow-up. The number of episodes decreased significantly even after cessation of all medications and headache disappeared in one patient and the two patients who had unsteady gait together with visual complaints showed remarkable improvement. Conclusion QCAC is one kind of pineal region ACs and it is advisable to plan the operative approach before the endoscopic procedure according to the different types of pineal region ACs. Pineal region ACs and the associated hydrocephalus can be successfully treated with simple, minimally invasive endoscopic procedure. PMID:26744082

  4. Endoscopic management of esophagogastric varices in Japan

    PubMed Central

    Ichikawa, Tatsuki; Taura, Naota; Miuma, Satoshi; Isomoto, Hajime; Nakao, Kazuhiko

    2014-01-01

    Esophagogastric varices are the most common complication in patients with portal hypertension, and endoscopy plays an important role in their diagnosis and in the prevention of acute bleeding from these structures. Recently, new modalities such as endoscopic ultrasonography (EUS) and narrow-band imaging have been introduced for the diagnosis of esophagogastric varices. In Japan, endoscopic therapy has become the first choice for the treatment of acutely bleeding esophageal or gastric varices. The two principal methods used to treat esophageal varices are endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL). Recently, combinations of EIS plus EVL and EVL plus argon plasma coagulation were reported to be more effective than EVL or EIS alone. Additionally, endoscopic cyanoacrylate injection is superior to EIS and EVL for the treatment of acutely bleeding gastric varices. PMID:25333017

  5. Endoscopic options for early stage esophageal cancer

    PubMed Central

    Shah, Pari M.

    2015-01-01

    Surgery has traditionally been the preferred treatment for early stage esophageal cancer. Recent advances in endoscopic treatments have been shown to be effective and safe. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) allow endoscopists to remove small, superficial lesions, providing tumor specimen that can be examined for accurate pathologic tumor staging and assessment of adequacy of resection. Endoscopic ablation procedures, including photodynamic therapy (PDT) and radio frequency ablation (RFA), have also been shown to safely and effectively treat esophageal dysplasia and early stage neoplasia, with excellent long-term disease control. Both approaches are becoming more widely available around the world, and provide an alternative, safe, low risk strategy for treating early stage disease, making combined endoscopic therapy the recommended treatment of choice for early stage esophageal cancers. PMID:25642334

  6. Endoscopic management of biliary hydatid disease

    PubMed Central

    Akkiz, Hikmet; Akinoglu, Alper; Çolakoglu, Salih; Demiryürek, Haluk; Yagmur, Özgür

    1996-01-01

    Objective To determine the effect of endoscopic sphincterotomy in the management of biliary hydatid disease. Design A case study between January 1992 and December 1994. Setting A university-affiliated hospital in Adana, Turkey. Patients Five patients with biliary hydatid disease, in which the cyst had ruptured into the biliary tree. The follow-up ranged from 3 to 12 months. Intervention Endoscopic sphincterotomy. Main Outcome Measures Morbidity, mortality and recurrence of the disease. Results All patients underwent successful endoscopic sphincterotomy, including removal of daughter cysts. During the follow-up period, ultrasonography and laboratory investigations showed complete cure in all patients. There were no complications due to endoscopic sphincterotomy. Conclusion Endoscopic sphincterotomy is the treatment of choice for the management of hydatid cysts that have ruptured into the biliary tract causing obstructive jaundice. PMID:8697318

  7. Outcomes in Endoscopic Ear Surgery.

    PubMed

    Kiringoda, Ruwan; Kozin, Elliott D; Lee, Daniel J

    2016-10-01

    Endoscopic ear surgery (EES) provides several advantages compared with traditional binocular microscopy, including a wide-field view, improved resolution with high magnification, and visual access to hidden corridors of the middle ear. Although binocular microscopic-assisted surgical techniques remain the gold standard for most otologists, EES is slowly emerging as a viable alternative for performing otologic surgery at several centers in the United States and abroad. In this review, we evaluate the current body of literature regarding EES outcomes, summarize our EES outcomes at the Massachusetts Eye and Ear Infirmary, and compare these results with data for microscopic-assisted otologic surgery. PMID:27565392

  8. [Endoscopic treatment of urethral strictures].

    PubMed

    Oosterlinck, W; Lumen, N

    2006-08-01

    The present article reviews the literature regarding the endoscopic treatment of urethral strictures. Only few prospective randomised clinical trials with sufficient power have been performed and most of the literature provides evidence of only level 3 and 4. Since length, location, extent and calibre of the urethral stricture have an important impact on prognosis, diagnosis and the role of ultrasonography are discussed. Pathophysiology of wound healing is discussed in relation to urethrotomy, as it explains the outcomes of the procedure. Operative techniques using cold knife and laser, use of endoprostheses, indications, complications, results and postoperative management are described. The possible role of urethral catheters, hydraulic dilatations and corticosteroid applications are discussed. PMID:16970069

  9. Current Endoscopic Treatment of Dysphonia

    PubMed Central

    Ossoff, Robert H.

    2000-01-01

    Benign laryngeal disorders result in dysphonia because of effects on glottic closure and the vibratory characteristics of the true vocal fold. Treatment is initially directed at reversing medical conditions and patterns of abuse with surgery reserved for unresolving lesions resulting in troublesome dysphonia. Benign lesions that require surgery are excised as precisely as possible sparing overlying mucosa and the underlying vocal ligament. Vocal fold scarring is currently best treated by augmentation procedures, and atrophy may be compensated for by medialization thyroplasty or by adding bulk to the affected folds. Application of current knowledge of laryngeal histology and physiology is prerequisite to endoscopic surgical intervention. PMID:18493531

  10. Integrated biophotonics in endoscopic oncology

    NASA Astrophysics Data System (ADS)

    Muguruma, Naoki; DaCosta, Ralph S.; Wilson, Brian C.; Marcon, Norman E.

    2009-02-01

    Gastrointestinal endoscopy has made great progress during last decade. Diagnostic accuracy can be enhanced by better training, improved dye-contrast techniques method, and the development of new image processing technologies. However, diagnosis using conventional endoscopy with white-light optical imaging is essentially limited by being based on morphological changes and/or visual attribution: hue, saturation and intensity, interpretation of which depends on the endoscopist's eye and brain. In microlesions in the gastrointestinal tract, we still rely ultimately on the histopathological diagnosis from biopsy specimens. Autofluorescence imaging system has been applied for lesions which have been difficult to morphologically recognize or are indistinct with conventional endoscope, and this approach has potential application for the diagnosis of dysplastic lesions and early cancers in the gastrointestinal tract, supplementing the information from white light endoscopy. This system has an advantage that it needs no administration of a photosensitive agent, making it suitable as a screening method for the early detection of neoplastic tissues. Narrow band imaging (NBI) is a novel endoscopic technique which can distinguish neoplastic and non-neoplastic lesions without chromoendoscopy. Magnifying endoscopy in combination with NBI has an obvious advantage, namely analysis of the epithelial pit pattern and the vascular network. This new technique allows a detailed visualization in early neoplastic lesions of esophagus, stomach and colon. However, problems remain; how to combine these technologies in an optimum diagnostic strategy, how to apply them into the algorithm for therapeutic decision-making, and how to standardize several classifications surrounding them. 'Molecular imaging' is a concept representing the most novel imaging methods in medicine, although the definition of the word is still controversial. In the field of gastrointestinal endoscopy, the future of

  11. Endoscopic palliation of tracheobronchial malignancies.

    PubMed Central

    Hetzel, M R; Smith, S G

    1991-01-01

    The prognosis for tracheobronchial tumours remains poor. Most patients can be offered only palliation. When the main symptom is breathlessness or refractory haemoptysis from a large airway tumour endoscopic treatment may be very effective. Over the last decade most attention has focused on the neodymium YAG laser. This often produces dramatic effects but has some important limitations. In the last few years better techniques for stenting and intrabronchial radiotherapy (brachytherapy) have also been developed. This article discusses the range of techniques now available and aims to help clinicians decide which patients may benefit from referral to centres providing these techniques. Images PMID:1712516

  12. Anterograde and Retrograde Amnesia of Place Discrimination in Retrosplenial Cortex and Hippocampal Lesioned Rats

    ERIC Educational Resources Information Center

    Haijima, Asahi; Ichitani, Yukio

    2008-01-01

    Retrograde and anterograde amnesic effects of excitotoxic lesions of the rat retrosplenial cortex (RS) and hippocampus (HPC) were investigated. To test retrograde amnesia, rats were trained with two-arm place discrimination in a radial maze 4 wk and 1 d before surgery with a different arm pair, respectively. In the retention test 1 wk after…

  13. [Klatskin tumors--diagnostic and interventional therapy].

    PubMed

    Ortner, M A

    2006-10-18

    Klatskin tumors are defined as malignant tumors of the bile duct involving the bifurcation and intrahepatic bile ducts. The most common presenting clinical feature, obstructive jaundice, usually occurs with advanced disease. Diagnostic tools currently available are therefore either performed too late or are not able to detect early disease stage. Imaging procedures for diagnosis and staging are ultrasonography, magnetic resonance imaging with cholangiopancreaticography, intravenous bolus-enhanced spiral computed tomography and endoscopic retrograde cholangiopancreaticography. Before initiating any palliative measure, a proper staging and a surgical consultation at a hepatobiliary center is necessary. To assess resectability, additional diagnostic methods like angiography, positron emission tomography, cholangioscopy, endoscopic or intraluminal ultrasonography and finally even explorative laparoscopy may be required. At time of diagnosis only a small percentage of Klatskin tumors is curative resectable. Therefore, palliative treatment options play an important role. Endoprostheses insertion is the method of choice to relieve jaundice. Although it improves quality of life, it does not seem to improve survival time. Definitive evidence for a benefit of additional radio and/or chemotherapy is still missing. Photodynamic therapy, a light therapy, is the first approach leading to an improvement of cholestasis and quality of life as well as to a prolongation of survival time. PDT should therefore be offered to all patients with nonresectable cholangiocarcinoma. PMID:17111849

  14. Performance characteristics of retrograde single-balloon endoscopy: A single center experience

    PubMed Central

    Christian, Kaci E; Kapoor, Karan; Goldberg, Eric M

    2016-01-01

    AIM To evaluate the technical success, diagnostic yield (DY) and therapeutic potential of retrograde single balloon enteroscopy (rSBE). METHODS A retrospective review of 136 rSBE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding (GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth (ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield (TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS A total of 136 rSBE procedures were identified. Mean patient age was 57.5 (± 16.2) years, 67 (49.2%) were male, and 110 (80.9%) procedures were performed on an outpatient basis. Indications for rSBE included GIB in 55 (40.4%), evaluation of inflammatory bowel disease (IBD) in 29 (21.3%), and imaging suggestive of pathology other than GIB or IBD in 43 (31.6%). Nine (6.6%) rSBEs were performed for other indications. Mean ID was 68.3 (± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7 (± 15.5) min. Overall, 73 (53.7%) cases were diagnostic and 25 (18.4%) cases were therapeutic in which interventions (argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88 (64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31 (35.2%) cases. Follow up data was available in 93 (68.4%) patients; 2 (2.2%) reported post-procedural abdominal

  15. Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions

    PubMed Central

    Chapman, Christopher G.; Waxman, Irving; Siddiqui, Uzma D.

    2016-01-01

    Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD. PMID:27012290

  16. Endoscopic Ultrasound (EUS)-Guided Pancreatic Duct Drainage: The Basics of When and How to Perform EUS-Guided Pancreatic Duct Interventions.

    PubMed

    Chapman, Christopher G; Waxman, Irving; Siddiqui, Uzma D

    2016-03-01

    Despite the advances in endoscopy, endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD) remains a technically challenging procedure. Technical success rates are greater than 70%; however, the average rate of adverse events is nearly 20%, which increases to 55% when stent migration is included. Until recently, a significant difficulty with this technique was the absence of dedicated devices. Proper patient selection is of utmost importance, and EUS-PDD should be reserved for patients who have failed endoscopic retrograde pancreatography. Furthermore, EUS-PDD must be performed by experienced endoscopists who are familiar with the technique. The most common indications include chronic pancreatitis induced strictures and stones, disconnected pancreatic ducts, inaccessible ampulla, and post-surgical altered anatomy. This manuscript will review the accessories used, techniques employed, and published literature reporting outcomes as well as adverse events regarding EUS-PDD. PMID:27012290

  17. Chronic compartment syndrome of the lower leg: a new diagnostic method using near-infrared spectroscopy and a new technique of endoscopic fasciotomy.

    PubMed

    Ota, Y; Senda, M; Hashizume, H; Inoue, H

    1999-05-01

    A 19-year-old female basketball player had chronic compartment syndrome. During basketball playing, she complained of bilateral lower leg pain that disappeared after several minutes of rest. The intracompartmental pressure in the anterior compartment was 41 mm Hg on the right side and 29 mm Hg on the left side immediately after playing. Prolonged ischemia of the anterior compartment was observed in comparison with four normal controls using near-infrared spectroscopy. Magnetic resonance imaging also revealed that the anterior compartment was mainly affected. Endoscopic fasciotomy was performed using an arthroscope, a transparent outer tube, and a retrograde blade. After the operation, her symptoms disappeared. Three months postoperatively, the anterior compartment pressure decreased and prolonged tissue ischemia improved. Endoscopic fasciotomy allowed us to cut the fascia safely and less invasively. We concluded that this technique is useful in treating chronic compartment syndrome in the anterior compartment of the lower leg. PMID:10355721

  18. Endoscopic evaluation and biopsy collection of the gastrointestinal tract in the green moray eel (Gymnothorax funebris): application in a case of chronic regurgitation with gastric mucus gland hyperplasia.

    PubMed

    Meegan, Jenny; Sidor, Inga F; Field, Cara; Roddy, Nicole; Sirpenski, Gayle; Dunn, J Lawrence

    2012-09-01

    A green moray eel (Gymnothorax funebris) was evaluated for chronic regurgitation. By using flexible endoscopy, the gastrointestinal tract was evaluated and revealed multifocal proliferative gastric masses and an intestinal ulcer. Biopsy specimens revealed gastric mucus gland hyperplasia, intestinal nematodiasis, and mild enteritis. Esophagoscopy and gastroscopy were performed by using a larger endoscope (length, 200 cm). A smaller endoscope (length, 100 cm) facilitated entering the intestinal tract in normograde or retrograde directions. A control eel was also evaluated, and no gross or histologic abnormalities were detected. The case eel was treated with metoclopramide and fenbendazole, responded well to therapy, and regurgitation decreased. A year later, the animal died of unrelated causes. Necropsy revealed coelomic gastric adhesions. The gastric proliferative lesions were associated with degeneration and necrosis of gastric pit mucosa without significant inflammation; etiology was unknown. Gastrointestinal endoscopy proved a useful diagnostic tool for evaluation and biopsy collection in this eel species. PMID:23082527

  19. Endoscopic bile duct and/or pancreatic duct cannulation technique for patients with surgically altered gastrointestinal anatomy.

    PubMed

    Okabe, Yoshinobu; Ishida, Yusuke; Kuraoka, Kei; Ushijima, Tomoyuki; Tsuruta, Osamu

    2014-04-01

    There are two major hurdles to carrying out endoscopic retrograde cholangiopancreatography (ERCP) in patients with altered gastrointestinal anatomy (Billroth II gastrectomy [B-II], Roux-en-Y anastomosis [R-Y] etc.), post-pancreatoduodenectomy or post-choledochojejunostomy. These are: (i) the endoscopic approach to the afferent loop, blind end, and the site of bilio-pancreatic anastomosis; and (ii) bile duct and/or pancreatic duct cannulation. Balloon-assisted enteroscopy (BAE) became available in recent years and is now being actively used to overcome the first hurdle and, at least, the success rate has improved. However, room for improvement still remains in regards to the second hurdle (i.e. the success rate of cannulation of the bile duct and/or pancreatic duct), and there has been a desire for the development of dedicated devices (ERCP catheters, hoods etc.) and for improvement in the functionality of the enteroscopes etc. In the present review, we explain the basic procedure for bile duct and/or pancreatic duct cannulation with conventional endoscopes and BAE, and modifications of the basic procedure. PMID:24750161

  20. Cannulation of the biliary tree under endoscopic control with an echoendoscope, without fluoroscopy: report of a case series

    PubMed Central

    Mangiavillano, Benedetto; Carrara, Silvia; Petrone, Maria Chiara; Santoro, Tara; Testoni, Pier Alberto

    2015-01-01

    Introduction: Endoscopic ultrasonography (EUS) is a validated technique allowing precise diagnosis and staging of pancreatic, biliary and ampullary disease. Developments in instruments and accessories have led to a more extensive use of this technology to perform operations. The use of EUS as an operative technique, alone or in conjunction with other endoscopic procedures, has already been described in the literature in several reports. However, despite the use of EUS, fluoroscopy has always been required to perform these operations. There are no data in the literature describing the feasibility, safety and efficacy of operative EUS in the treatment of common bile duct (CBD) obstruction, following a malignant or benign disease, performed completely under EUS guidance without fluoroscopic assistance. Methods: In this series we describe three cases of EUS treatment of CBD diseases performed without fluoroscopic assistance. Results: All the cases were treated by EUS without fluoroscopic assistance and no complications were encountered. Conclusion: Operative EUS without fluoroscopy appears to be a feasible technique. Its major advantages could be to shorten the examination time and to enable biliary or pancreatic operative endoscopy in patients in whom fluoroscopy could be dangerous, such as pregnant women. The endoscopist should have a good training both in EUS and endoscopic retrograde cholangiopancreatography. Prospective, larger studies are needed to confirm our preliminary data. PMID:25949525

  1. 'Single-Sitting' Laparoscopic Cholecystectomy and Endoscopic Removal of Common Bile Duct Stone for Cholelithiasis and Choledocholithiasis: a Feasibility Study.

    PubMed

    Ibrarullah, Md; Mishra, Tapas; Dash, Ambika P; Mohapatra, Devanand; Modi, M S

    2015-12-01

    'Single-sitting' laparoscopic cholecystectomy followed by endoscopic common bile duct clearance is emerging as a viable option for management of cholelithiasis and concomitant choledocholithiasis. The only disadvantage of the procedure is logistical since it requires co-ordination between two teams-the surgeons and the endoscopists. This limitation can be overcome in centres where both the procedures are performed by one team. With a considerable experience in endoscopy, we conducted a prospective study in a select group of patients to assess the feasibility of this single-sitting approach. The study included 38 patients with a radiological diagnosis of choledocholithiasis or jaundice at presentation. After laparoscopic cholecystectomy, the patients were turned prone and subjected to endoscopic retrograde cholangiogram, sphincterotomy and extraction of the common bile duct stone. The procedure was successful in 33 (87 %) of patients. The mean procedure time and hospital stay were 2 h, 20 min and 2 days, respectively. None of the patients had any major complications. We conclude that in a select group of patients, single-sitting laparoscopic cholecystectomy followed by endoscopic clearance of the common bile duct stone is safe and effective. PMID:26730094

  2. Therapeutic aspects of endoscopic ultrasound

    NASA Astrophysics Data System (ADS)

    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.

  3. Novel Endoscopic Management of Obesity

    PubMed Central

    Dargent, Jerome

    2016-01-01

    Endoscopic procedures have been well-documented in the obesity field, but have not yet reached a sufficient level of evidence as stand-alone methods for treating obesity. It is unclear if they should take over. Although expanding, the array of bariatric surgical techniques does not fully meet the current needs, and there are not enough resources for increasing surgery. Surgery is avoided by a majority of patients, so that less aggressive procedures are necessary. For the time being, relevant endoscopic methods include intra-gastric balloons, gastric partitioning (Endo-plication), and the metabolic field (Endo-barrier). Surgical novelties and basic research are also important contributors owing to their potential combination with endoscopy. Conditions have been listed for implementation of bariatric endoscopy, because innovation is risky, expensive, and faces ethical challenges. A scientific background is being built (e.g., hormonal studies). Some techniques require additional study, while others are not ready but should be priorities. Steps and goals include the search for conceptual similarities and the respect of an ethical frame. Minimally invasive bariatric techniques are not ready for prime time, but they are already being successful as re-do procedures. A time-frame for step-strategies can be defined, and more investments from the industry are mandatory. PMID:26855921

  4. Endoscopic parathyroidectomy in primary hyperparathyroidism.

    PubMed

    Prades, Jean-Michel; Asanau, Alexander; Timoshenko, Andrei P; Gavid, Marie; Martin, Christian

    2011-06-01

    During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice. PMID:21046411

  5. Technological fundamentals of endoscopic haemostasis.

    PubMed

    Reidenbach, H D

    1992-01-01

    In order to perform endoscopic haemostasis there exist several different mechanical, biochemical and thermal methods, which may be applied together with rigid or fully flexible endoscopes in different situations. The technological fundamentals of convective, conductive and radiative heat transfer, the irradiation with coherent electromagnetic waves like microwaves and laser radiation and the resistive heating by RF-current are described. A review of the state of the art of haemostatic coagulation by laser radiation (photocoagulation) and radio-frequency currents (surgical diathermy, high-frequency coagulation) is given. The wavelength-dependent interactions of coherent light waves are compared especially for the three mainly different laser types, i.e., carbon-dioxide-, neodymium-YAG- and argon-ion-laser. The well-known disadvantages of the conventional RF-coagulation are overcome by the so-called electrohydrothermosation (EHT), i.e. the liquid-assisted application of resistive heating of biological tissues to perform haemostasis. Different technological solutions for bipolar RF-coagulation probes including ball-tips and forceps are shown and the first experimental results are discussed in comparison. PMID:1595405

  6. Endoscopic Ultrasound of the Upper Gastrointestinal Tract and Mediastinum: Diagnosis and Therapy

    SciTech Connect

    Prasad, Priyajit; Wittmann, Johannes; Pereira, Stephen P.

    2006-12-15

    Endoscopic ultrasound (EUS) has developed significantly over the last two decades and has had a considerable impact on the imaging and staging of mass lesions within or in close proximity to the gastrointestinal (GI) tract. In conjunction with conventional imaging such as helical computed tomography and magnetic resonance imaging, the indications for EUS include (1) differentiating between benign and malignant lesions of the mediastinum and upper GI tract, (2) staging malignant tumors of the lung, esophagus, stomach, and pancreas prior to surgery or oncological treatment, (3) excluding common bile duct stones before laparoscopic cholecystectomy, thereby avoiding the need for endoscopic retrograde cholangiopancreatography (ERCP) in some patients, and (4) assessing suspected lesions that are either equivocal or not seen on conventional imaging. In recent years, EUS has charted a course similar to that taken by ERCP, evolving from a purely diagnostic modality to one that is interventional and therapeutic. These indications include (5) obtaining a tissue diagnosis by EUS-guided fine-needle aspiration or trucut-type needle biopsy and (6) providing therapy such as coeliac plexus neurolysis and pancreatic pseudocyst drainage-in many cases, more accurately and safely than conventional techniques. Emerging investigational techniques include EUS-guided enteric anastomosis formation and fine-needle injection therapy for malignant disease.

  7. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

    PubMed Central

    Hara, Kazuo; Yamao, Kenji; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tutomu; Ishihara, Makoto; Okuno, Nozomi; Hieda, Nobuhiro; Yoshida, Tukasa; Niwa, Yasumasa

    2016-01-01

    Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor’s supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future. PMID:26811666

  8. Endoscopic ultrasound-guided treatments: Are we getting evidence based - a systematic review

    PubMed Central

    Fabbri, Carlo; Luigiano, Carmelo; Lisotti, Andrea; Cennamo, Vincenzo; Virgilio, Clara; Caletti, Giancarlo; Fusaroli, Pietro

    2014-01-01

    The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field. PMID:25024600

  9. The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage

    PubMed Central

    Kim, Hong Jun; Lee, Sung Koo; Ryu, Choong Heon; Park, Do Hyun; Lee, Sang Soo; Seo, Dong Wan; Kim, Myung-Hwan

    2015-01-01

    Background/Aims: To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD) as a new method of draining multiple bile duct obstructions. Methods: A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course. Results: Of the 38 patients who underwent double ENBD, 20 (52.6%) had Klatskin tumors, 12 (31.6%) had hepatocellular carcinoma, 3 (7.9%) had strictures at the anastomotic site following liver transplantation, and 3 (7.9%) had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%), drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%), obtain cholangiography in 4 (10.5%), drain hemobilia in 3 (7.9%), relieve Mirizzi syndrome with cholangitis in 3 (7.9%), and relieve jaundice in 3 (7.9%). Conclusions: Double ENBD may be useful in patients with multiple biliary obstructions. PMID:26668802

  10. Endoscopic ultrasonography-guided biliary drainage: Who, when, which, and how?

    PubMed

    Hara, Kazuo; Yamao, Kenji; Mizuno, Nobumasa; Hijioka, Susumu; Imaoka, Hiroshi; Tajika, Masahiro; Tanaka, Tutomu; Ishihara, Makoto; Okuno, Nozomi; Hieda, Nobuhiro; Yoshida, Tukasa; Niwa, Yasumasa

    2016-01-21

    Both endoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) and EUS-guided hepaticogastrostomy (EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage (PTBD). Both EUS-CDS and EUS-HGS have high technical and clinical success rates (more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUS-guided biliary drainage (EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique (EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUS-BD will potentially become a first-line biliary drainage procedure in the near future. PMID:26811666

  11. Adjunctive radiofrequency ablation for the endoscopic treatment of ampullary lesions with intraductal extension (with video)

    PubMed Central

    Suarez, Alejandro L.; Coté, Gregory A.; Elmunzer, B. Joseph

    2016-01-01

    Background and study aims: Catheter-based radiofrequency ablation (RFA) delivered during endoscopic retrograde cholangiopancreatography (ERCP) may represent a viable treatment option for intraductal extension of ampullary neoplasms, however, clinical experience with this modality is limited. After ampullary resection, 4 patients with intraductal extension underwent adjunctive RFA of the distal bile duct. All patients received a temporary pancreatic stent to reduce the risk of pancreatitis, as well as a plastic biliary stent to prevent biliary obstruction. Three patients were treated for adenoma and 1 for adenoma with a focus of adenocarcinoma. During a short follow-up period, 3 patients experienced complete eradication of the target lesion, whereas the patient with a focus of adenocarcinoma had progression to overt invasive cancer. There were no immediate adverse events. One patient developed a post-RFA bile duct stricture, which has required additional endoscopic therapy. Catheter-based RFA of ampullary lesions that extend up the bile duct is technically feasible. Additional research is necessary to understand the risks and long-term benefits of this technique.

  12. Left Subclavian Artery Occlusion: Femoro-Axillary Artery Retrograde Bypass

    PubMed Central

    Nakashima, Masaya; Kobayashi, Hideaki; Kobayashi, Masayoshi

    2016-01-01

    The treatment tactics for subclavian artery occlusion include the more commonly used endovascular therapy rather than surgical intervention. We present a case of a 61-year-old woman with dialysis-dependent chronic renal failure who experienced left finger necrosis in the left upper extremity. To salvage the limb, we performed femoro-axillary (fem-ax) artery bypass using an autologous saphenous vein graft. However, 10 months later, she experienced coldness in the left forearm. Angiography revealed chronic total occlusion of the venous bypass. Despite emergent thrombectomy, redo fem-ax artery bypass operation was performed using a prosthetic graft. Upper limb salvage can be achieved by fem-ax artery retrograde bypass. PMID:27386454

  13. Emotion-induced retrograde amnesia and trait anxiety.

    PubMed

    Miu, Andrei C; Heilman, Renata M; Opre, Adrian; Miclea, Mircea

    2005-11-01

    Emotional arousal can both enhance and impair memory. Considering that both emotional memory and trait anxiety (TA) have been associated with adrenergic activity, the authors investigated whether there is an association between 2 opposite emotional memory biases and the TA. The authors used a procedure recently put forward by B. A. Strange, R. Hurlemann, and R. J. Dolan (2003) to elicit an emotion-induced retrograde amnesia (ERA) coupled to an emotional memory enhancement (EME). The authors contrasted the association between these emotional memory biases and the TA in several conditions involving different levels of encoding and types of recall. The results presented here indicated a significant interaction of the TA with EME and ERA and the dependency of these biases on the consciously controlled use of memory. PMID:16393044

  14. Inhibition of wheat starch retrogradation by tea derivatives.

    PubMed

    Zhang, Haihua; Sun, Binghua; Zhang, Shikang; Zhu, Yuejin; Tian, Yaoqi

    2015-12-10

    The effect of four industrial tea derivatives (tea polyphenols [TPS], tea water-soluble extracts [TSE], tea polysaccharides [TSS], and green tea powder [GTP]), on the retrogradation of wheat starch was investigated using texture profile analysis (TPA), differential scanning calorimetry (DSC), rapid viscosity analysis (RVA), and the α-amylase-iodine method. The addition of the four tea derivatives resulted in decreased hardness and increased cohesiveness of the starch gel as shown by the TPA test. The DSC data demonstrated an increase in the enthalpy change of starch gelatinization and a decrease in the enthalpy change of starch recrystallite dissociation. The RVA results indicated that the peak viscosity, representing the intermolecular forces of wheat starch, was reduced after addition of TPS, TSE, and TSS, respectively, but was increased by GTP. Furthermore, the half crystallization time in the Avrami equation almost doubled after the separate addition of the tea derivatives. PMID:26428142

  15. Retrograde nailing for distal femur fractures in the elderly

    PubMed Central

    Giddie, Jasdeep; Sawalha, Seif; Parker, Martyn

    2015-01-01

    Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years), 52/54 (96%) were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3%) and the one year mortality was 17/54 (31.5%). Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients. PMID:27163086

  16. CONFIRMATION OF A RETROGRADE ORBIT FOR EXOPLANET WASP-17b

    SciTech Connect

    Bayliss, Daniel D. R.; Sackett, Penny D.; Winn, Joshua N.; Mardling, Rosemary A.

    2010-10-20

    We present high-precision radial velocity observations of WASP-17 throughout the transit of its close-in giant planet, using the MIKE spectrograph on the 6.5 m Magellan Telescope at Las Campanas Observatory. By modeling the Rossiter-McLaughlin effect, we find the sky-projected spin-orbit angle to be {lambda} = 167.4 {+-} 11.2 deg. This independently confirms the previous finding that WASP-17b is on a retrograde orbit, suggesting it underwent migration via a mechanism other than just the gravitational interaction between the planet and the disk. Interestingly, our result for {lambda} differs by 45 {+-} 13 deg from the previously announced value, and we also find that the spectroscopic transit occurs 15 {+-} 5 minutes earlier than expected, based on the published ephemeris. The discrepancy in the ephemeris highlights the need for contemporaneous spectroscopic and photometric transit observations whenever possible.

  17. Extracervical approaches to endoscopic thyroid surgery.

    PubMed

    Papaspyrou, Giorgos; Ferlito, Alfio; Silver, Carl E; Werner, Jochen A; Genden, Eric; Sesterhenn, Andreas M

    2011-04-01

    There is increasing demand for surgical procedures which avoid visible scars while maintaining optimal functional and ideal cosmetic results, without compromising the safety or effectiveness of the procedure. Endoscopic techniques have been adapted to abdominal and pelvic surgery and increasingly employed over the past three decades. Although hampered by the absence of a natural cavity, endoscopic techniques have been adapted to surgery in the neck for the past 15 years, particularly for the thyroid gland. While earlier attempts at endoscopic thyroid surgery were performed through incisions in or near the midline of the neck, recent techniques have been developed to place the incisions and endoscopic ports extracervically, or at least away from the midline region of the neck, rendering the cosmetic result more acceptable. Most of these approaches are through the axilla, breast, chest wall or a combination of approaches. Visualization of the thyroid and rate of complications with these approaches are equal to those attained with older endoscopic approaches. Careful patient selection is important for endoscopic surgery. Complications unique to the endoscopic approach are mostly related to insufflation of cervical tissues with pressurized CO(2). PMID:20844894

  18. Endoscopic mediastinal staging of lung cancer.

    PubMed

    Khoo, Kay-Leong; Ho, Khek-Yu

    2011-04-01

    The advent of endoscopic ultrasound-guided sampling procedures such as endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has lead to significant advances in the mediastinal diagnosis and staging of lung cancer. These endoscopic techniques can be performed in the outpatient setting under conscious sedation and local anesthesia, in contrast to the surgical standard, mediastinoscopy (MS), which requires operating theatre time and general anesthesia. Proponents of mediastinoscopy have always emphasized the advantages of mediastinoscopy, namely its sensitivity even with a low prevalence of mediastinal metastases and its low false negative rate. Newer endoscopic techniques such as EBUS-TBNA are showing sensitivities exceeding that of mediastinoscopy, even in the setting of an equally low prevalence of mediastinal metastases. However, endoscopic techniques have double the false negative rate of mediastinoscopy. As the tracheobronchial route and esophageal route provide almost complete access to mediastinal lymph nodes, these endoscopic techniques are complementary rather than competing. When used in combination, it is possible mediastinoscopy may be superseded. The challenge however, is how best to select the appropriate endoscopic procedures to accurately stage lung cancer in the most cost-effective manner. PMID:21130638

  19. Laser scanning endoscope for diagnostic medicine

    NASA Astrophysics Data System (ADS)

    Ouimette, Donald R.; Nudelman, Sol; Spackman, Thomas; Zaccheo, Scott

    1990-07-01

    A new type of endoscope is being developed which utilizes an optical raster scanning system for imaging through an endoscope. The optical raster scanner utilizes a high speed, multifaceted, rotating polygon mirror system for horizontal deflection, and a slower speed galvanometer driven mirror as the vertical deflection system. When used in combination, the optical raster scanner traces out a raster similar to an electron beam raster used in television systems. This flying spot of light can then be detected by various types of photosensitive detectors to generate a video image of the surface or scene being illuminated by the scanning beam. The optical raster scanner has been coupled to an endoscope. The raster is projected down the endoscope, thereby illuminating the object to be imaged at the distal end of the endoscope. Elemental photodetectors are placed at the distal or proximal end of the endoscope to detect the reflected illumination from the flying spot of light. This time sequenced signal is captured by an image processor for display and processing. This technique offers the possibility for very small diameter endoscopes since illumination channel requirements are eliminated. Using various lasers, very specific spectral selectivity can be achieved to optimum contrast of specific lesions of interest. Using several laser lines, or a white light source, with detectors of specific spectral response, multiple spectrally selected images can be acquired simultaneously. The potential for co-linear therapy delivery while imaging is also possible.

  20. Comparison of antegrade and retrograde laparoscopic radical prostatectomy techniques.

    PubMed

    Tugcu, Volkan; Sahin, Selcuk; Resorlu, Berkan; Yigitbasi, Ismail; Yavuzsan, Abdullah H; Tasci, Ali I

    2016-08-01

    We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244±18.3 vs. 203.3±18.4 min, p<0.001), whereas mean anastomosis times for both groups were similar (35.8±7.2 vs. 34.7±5.8 min, p=0.155). Estimated blood loss and transfusion rates were significantly lower in Group 2. A significant difference was observed for both hospitalization (6.79±3.3 vs. 5.46±3.08 days, respectively; p=0.026) and catheterization times (12.24±2.1 vs. 11±1.08 days, respectively; p=0.001) for Group 2. The total complication rate was 47.6% in Group 1, and 11.8% in Group 2 (p<0.01). Rates of positive surgical margins were 14.2% and 15% for Groups 1 and 2, respectively. At the 12-month interval from operation, similar recoveries in urinary continence were obtained for both groups (81% in Group 1; 91% in Group 2). Upon comparison of the two LRP techniques, we found that both were effective; however, the latter resulted in lower minor complication rate, lower blood loss, shorter operation time, and shorter length of hospital stay. PMID:27523453

  1. Primary Retrograde Tibiotalocalcaneal Nailing For Fragility Ankle Fractures

    PubMed Central

    Taylor, Benjamin C.; Hansen, Dane C.; Harrison, Ryan; Lucas, Douglas E; Degenova, Daniel

    2016-01-01

    Background Ankle fragility fractures are difficult to treat due to poor bone quality and soft tissues as well as the near ubiquitous presence of comorbidities including diabetes mellitus and peripheral neuropathy. Conventional open reduction and internal fixation in this population has been shown to lead to a significant rate of complications. Given the high rate of complications with contemporary fixation methods, the present study aims to critically evaluate the use of acute hindfoot nailing as a percutaneous fixation technique for high-risk ankle fragility fractures. Methods In this study, we retrospectively evaluated 31 patients treated with primary retrograde tibiotalocalcaneal nail without joint preparation for a mean of 13.6 months postoperatively from an urban Level I trauma center during the years 2006-2012. Results Overall, there were two superficial infections (6.5%) and three deep infections (9.7%) in the series. There were 28 (90.3%) patients that went on to radiographic union at a mean of 22.2 weeks with maintenance of foot and ankle alignment. There were three cases of asymptomatic screw breakage observed at a mean of 18.3 months postoperatively, which were all treated conservatively.. Conclusions This study shows that retrograde hindfoot nailing is an acceptable treatment option for treatment of ankle fragility fractures. Hindfoot nailing allows early weightbearing, limited soft tissue injury, and a relatively low rate of complications, all of which are advantages to conventional open reduction internal fixation techniques. Given these findings, larger prospective randomized trials comparing this treatment with conventional open reduction internal fixation techniques are warranted. PMID:27528840

  2. Experience with endoscopic holmium laser in the pediatric population

    NASA Astrophysics Data System (ADS)

    Merguerian, Paul A.; Reddy, Pramod P.; Barrieras, Diego; Bagli, Darius J.; McLorie, Gordon A.; Khoury, Antoine E.

    1999-06-01

    Introduction: Due to the unavailability of suitable endoscopic instruments, pediatric patients have not benefited fully from the technological advances in the endoscopic management of the upper urinary tract. This limitation may be overcome with the Holmuim:Yttrium-Aluminum-Garnet(Ho:YAG) laser delivered via small instruments. To date, there is no published report on the use of this modality in children. Purpose: We evaluated the indications, efficacy, and complications of endourological Ho:YAG laser surgery in the treatment of pediatric urolithiasis, posterior urethral valves, ureterocele and ureteropelvic junction obstruction. Methods: The patient population included 10 children with renal, ureteral and bladder calculi, 2 children with posterior urethral valves, 2 children with obstructing ureteroceles, 2 children with ureteropelvic junction obstruction and 1 child with a urethral stricture. Access to the lesions was either antegrade via a percutaneous nephrostomy tract or retrograde via the urethra. A solid state Ho:YAG laser with maximum output of 30 watts (New Star lasers, Auburn, CA) was utilized as the energy source. Results: A total of 10 patients underwent laser lithotripsy. The means age of the patients was 9 yrs (5-13 yrs). The average surface area of the calculi as 425.2 mm2 (92-1645 mm2). 8 of the patients required one procedure to render them stone free, one patient had a staghorn calculus filling every calyx of a solitary kidney requiring multiple treatments and one other patient with a staghorn calculus required 2 treatments. There were no complications related to the laser lithotripsy. Two newborn underwent successful ablation of po sterious urethral valves. Two infants underwent incision of obstructing ureteroceles with decompression of the ureterocele on postoperative ultrasound. Two children underwent endypyelotomy for ureteropelvic junction obstruction. One was successful an done required an open procedure to correct the obstruction. One child

  3. Endoscopic Ultrasound-guided Bilio-pancreatic Drainage

    PubMed Central

    Giovannini, Marc; Bories, Erwan; Téllez-Ávila, Félix I.

    2012-01-01

    The echoendoscopic biliary drainage is an option to treat obstructive jaundices when endoscopic retrograde cholangiopancreatography (ERCP) drainage fails. These procedures compose alternative methods to the side of surgery and percutaneous transhepatic biliary drainage, and it was only possible by the continuous development and improvement of echoendoscopes and accessories. The development of linear sectorial array echoendoscopes in early 1990 brought a new approach to diagnostic and therapeutic dimension on echoendoscopy capabilities, opening the possibility to perform punction over direct ultrasonografic view. Despite of the high success rate and low morbidity of biliary drainage obtained by ERCP, difficulty could be found at the presence of stent tumor ingrown, tumor gut compression, periampullary diverticula and anatomic variation. The echoendoscopic technique starts performing punction and contrast of the left biliary tree. When performed from gastric wall, the access is made through hepatic segment III. From duodenum, direct common bile duct punction. Diathermic dilatation of the puncturing tract is required using a 6-Fr cystostome and a plastic or metal stent is introducted. The techincal success of hepaticogastrostomy is near 98%, and complications are present in 20%: pneumoperitoneum, choleperitoneum, infection and stent disfunction. To prevent bile leakage, we have used the 2-stent techniques. The first stent introduced was a long uncovered metal stent (8 or 10 cm) and inside this first stent a second fully covered stent of 6 cm was delivered to bridge the bile duct and the stomach. Choledochoduodenostomy overall success rate is 92%, and described complications include, in frequency order, pneumoperitoneum and focal bile peritonitis, present in 14%. By the last 10 years, the technique was especially performed in reference centers, by ERCP experienced groups, and this seems to be a general guideline to safer procedure execution. The ideal approach for

  4. Endoscopic Optical Coherence Tomography for Clinical Gastroenterology

    PubMed Central

    Tsai, Tsung-Han; Fujimoto, James G.; Mashimo, Hiroshi

    2014-01-01

    Optical coherence tomography (OCT) is a real-time optical imaging technique that is similar in principle to ultrasonography, but employs light instead of sound waves and allows depth-resolved images with near-microscopic resolution. Endoscopic OCT allows the evaluation of broad-field and subsurface areas and can be used ancillary to standard endoscopy, narrow band imaging, chromoendoscopy, magnification endoscopy, and confocal endomicroscopy. This review article will provide an overview of the clinical utility of endoscopic OCT in the gastrointestinal tract and of recent achievements using state-of-the-art endoscopic 3D-OCT imaging systems. PMID:26852678

  5. Endoscopic photodynamic therapy (PDT) for oesophageal cancer.

    PubMed

    Moghissi, Keyvan

    2006-06-01

    Endoscopic photodynamic therapy (PDT) is undertaken only when tumour is visible endoscopically with malignancy biopsy confirmed. Patients will be either Group A: inoperable cases with locally advanced cancer when the aim is palliation of dysphagia, or Group E: patients with early stage I-II disease who are unsuitable for surgery or decline operation, when the intent is curative. Following assessment for suitability for PDT and counselling, Photofrin 2mg/(kgbw) is administered 24-72h before endoscopic illumination using a Diode 630nm laser. Illumination may be either interstitial or intraluminal at a dose of 100-200J/cm. PMID:25049097

  6. [A short history of endoscopic neurosurgery].

    PubMed

    Wang, Long; Song, Zhi-Bin; Gao, Jian-Wei; Li, Xu-Guangl

    2013-11-01

    Since 1910, rigid cystoscopy was first applied in the lateral ventricular choroid plexus cauterization for the treatment of congenital hydrocephalus, thus, opening up a new window in the endoscopic neurosurgery, but poor surgical outcome and high mortality made the application of endoscopic neurosurgery in question. Latterly, because of the appearance of new microscope and optical fiber endoscope, neuroendoscopy has been applied adequately in neurosurgery, with the increase of its clinical indications. Along with it, the concept of neuroendoscopy in surgery has changed, as well as the expansion of clinical indications. At present, neuroendoscopy technology has become a significant branch of modern neurosurgery. PMID:24524639

  7. Evolving techniques for gastrointestinal endoscopic hemostasis treatment.

    PubMed

    Ghassemi, Kevin A; Jensen, Dennis M

    2016-05-01

    With mortality due to gastrointestinal (GI) bleeding remaining stable, the focus on endoscopic hemostasis has been on improving other outcomes such as rebleeding rate, need for transfusions, and need for angiographic embolization or surgery. Over the past few years, a number of devices have emerged to help endoscopically assess and treat bleeding GI lesions. These include the Doppler endoscopic probe, hemostatic powder, and over-the-scope clip. Also, new applications have been described for radiofrequency ablation. In this article, we will discuss these evolving tools and techniques that have been developed, including an analysis of their efficacy and limitations. PMID:26651414

  8. Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing, self-expandable fully covered metal stent for palliative biliary drainage.

    PubMed

    French, Joshua Blake; Coe, Adam Wesley; Pawa, Rishi

    2016-04-01

    In addition to the poor prognosis associated with pancreatic adenocarcinoma, it can also lead to several other conditions including obstructive jaundice that can affect a patient's quality of life. This is a major concern in non-operative patients where palliation is considered the main therapeutic goal. Traditionally, there are several ways to pursue palliative biliary drainage including endoscopic methods, a variety of surgical procedures, and percutaneous techniques. Generally, endoscopic methods such as endoscopic retrograde cholangiopancreatography (ERCP) with transpapillary stent placement are considered first-line therapies. Unfortunately, ERCP is not always possible due to several potential reasons. Although endoscopic ultrasound-guided biliary puncture has been well described for several years, there are limitations to its usefulness in biliary drainage, in part due to complication concerns. However, more recently a lumen-apposing, self-expandable fully covered metal stent has been employed for such situations. We describe two cases in which this type of stent was used in patients for palliative biliary drainage in pancreatic adenocarcinoma where standard ERCP was not feasible. In both cases, stent deployment was successful without immediate complications related to the procedure or the stent. Furthermore, the main goal of these therapies was palliation and in both cases the patient chose this procedure for quality of life reasons. In the future, randomized trials are needed to better define the long-term effectiveness and safety of these stents compared to more standard therapies. PMID:26956721

  9. Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: Case report.

    PubMed

    Suzuki, Keiichi; Higuchi, Hajime; Shimizu, Sayaka; Nakano, Masaru; Serizawa, Hiroshi; Morinaga, Shojiro

    2015-07-14

    Solitary duodenal Peutz-Jeghers (PJ)-type hamartomatous polyps are rare and considered a different disease entity than classic PJ syndrome. We describe the case of an 89-year-old man admitted to our emergency department with symptoms of acute cholangitis, liver dysfunction, and slight jaundice. Magnetic resonance imaging showed multiple signal voids, reflecting choledocholithiasis, and an oval-shaped tumor in the common bile duct (CBD). Following endoscopic retrograde cholangiopancreatography, the patient was diagnosed with a lower CBD tumor 20 mm in diameter. Endoscopic sphincterotomy was performed for choledocholithotomy, resulting in the expulsion of a large tumor with a stalk connected to the papilla of Vater. The tumor was successfully excised en bloc by endoscopic snare papillectomy. Histopathologic examination showed that the tumor was a PJ-type hamartomatous polyp. No mucocutaneous pigmentation of the skin was evident and the patient's family history was negative. Solitary duodenal PJ-type hamartomatous polyps are usually diagnosed incidentally during endoscopy for other indications because most of these tumors are asymptomatic or have nonspecific presentations. To our knowledge, this is the first reported solitary PJ-type polyp with intra-CBD growth treated by endoscopic snare papillectomy. PMID:26185397

  10. Endoscopic ultrasonography guided biliary drainage: Summary of consortium meeting, May 7th, 2011, Chicago

    PubMed Central

    Kahaleh, Michel; Artifon, Everson LA; Perez-Miranda, Manuel; Gupta, Kapil; Itoi, Takao; Binmoeller, Kenneth F; Giovannini, Marc

    2013-01-01

    Endoscopic retrograde cholangiopancreatography (ERCP) has become the preferred procedure for biliary or pancreatic drainage in various pancreatico-biliary disorders. With a success rate of more than 90%, ERCP may not achieve biliary or pancreatic drainage in cases with altered anatomy or with tumors obstructing access to the duodenum. In the past those failures were typically managed exclusively by percutaneous approaches by interventional radiologists or surgical intervention. The morbidity associated was significant especially in those patients with advanced malignancy, seeking minimally invasive interventions and improved quality of life. With the advent of biliary drainage via endoscopic ultrasound (EUS) guidance, EUS guided biliary drainage has been used more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that encompasses various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS guided biliary and pancreatic drainage techniques. This diversity has resulted in variations and improvements in EUS Guided biliary and pancreatic drainage; and over the years has led to an extensive nomenclature. The diversity of techniques, nomenclature and recent progress in our intrumentation has led to a dedicated meeting on May 7th, 2011 during Digestive Disease Week 2011. More than 40 advanced endoscopists from United States, Brazil, Mexico, Venezuela, Colombia, Italy, France, Austria, Germany, Spain, Japan, China, South Korea and India attended this pivotal meeting. The meeting covered improved EUS guided biliary access and drainage procedures, terminology, nomenclature, training and credentialing; as well as emerging devices for EUS guided biliary drainage. This paper summarizes the meeting’s agenda and the conclusions generated by the creation of this consortium group. PMID:23538784

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

    PubMed

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

    2015-01-22

    The effect of pullulan (PUL) on the retrogradation of rice starch (RS) was investigated by means of rapid visco-analyzer (RVA), rotational rheometer, differential scanning calorimetry (DSC), and X-ray diffraction (XRD). RVA results showed that addition of pullulan significantly decreased the breakdown and setback values, which meant that the short-term retrogradation of RS was inhibited. The dynamic time sweep of samples also proved the retarding effect of pullulan on the retrogradation of RS. DSC curves showed clearly that pullulan significantly reduced the retrogradation enthalpy of amylopectin, and the kinetics of retrogradation was analyzed using the Avrami model. XRD results showed that recrystallinity of RS was reduced from 11.565% to 8.841% with the addition of pullulan and this was in line with the DSC results. It could be concluded that the addition of pullulan apparently influenced not only the short-term retrogradation of amylose, but also the long-term retrogradation of amylopectin. PMID:25439913

  12. Identification of the main retrogradation-related properties of rice starch.

    PubMed

    Lian, Xijun; Kang, Haiqi; Sun, Haibo; Liu, Lizeng; Li, Lin

    2015-02-11

    The retrogradation of rice in shelf life is the biggest barrier to the industrial production of traditional foods using rice as material. Many rice breeders have tried their best to screen low-retrogradation rice cultivars without a specific indicator. To identify the main retrogradation-related properties of rice, the starch, amylose, and amylopectin from 16 rice cultivars were extracted from rice powder and their physicochemical properties, such as visible absorbance, infrared, average molecule weight (amylopectin), chain-length distribution (amylopectin), X-ray diffraction, and differential scanning calorimetry, were determined. The correlation between starch retrogradation rates and those physicochemical properties was investigated. The results show that a significant positive correlation (R(2) = 0.85; r = 0.926; p < 0.01) exists only between proportions of the chains [degree of polymerization (DP) > 10] in amylopectin and the retrogradation rates of different rice starches. The findings in the paper offer a shortcut for rice breeders to screen cultivars with a low retrogradation rate. Because the genes related to the branching enzyme control the DP of amylopectin, they can be exploited as molecular markers to screen low-retrogradation rice cultivars. PMID:25615262

  13. RAB-6.1 and RAB-6.2 Promote Retrograde Transport in C. elegans

    PubMed Central

    Zhang, Donglei; Dubey, Jyoti; Koushika, Sandhya P.; Rongo, Christopher

    2016-01-01

    Retrograde transport is a critical mechanism for recycling certain membrane cargo. Following endocytosis from the plasma membrane, retrograde cargo is moved from early endosomes to Golgi followed by transport (recycling) back to the plasma membrane. The complete molecular and cellular mechanisms of retrograde transport remain unclear. The small GTPase RAB-6.2 mediates the retrograde recycling of the AMPA-type glutamate receptor (AMPAR) subunit GLR-1 in C. elegans neurons. Here we show that RAB-6.2 and a close paralog, RAB-6.1, together regulate retrograde transport in both neurons and non-neuronal tissue. Mutants for rab-6.1 or rab-6.2 fail to recycle GLR-1 receptors, resulting in GLR-1 turnover and behavioral defects indicative of diminished GLR-1 function. Loss of both rab-6.1 and rab-6.2 results in an additive effect on GLR-1 retrograde recycling, indicating that these two C. elegans Rab6 isoforms have overlapping functions. MIG-14 (Wntless) protein, which undergoes retrograde recycling, undergoes a similar degradation in intestinal epithelia in both rab-6.1 and rab-6.2 mutants, suggesting a broader role for these proteins in retrograde transport. Surprisingly, MIG-14 is localized to separate, spatially segregated endosomal compartments in rab-6.1 mutants compared to rab-6.2 mutants. Our results indicate that RAB-6.1 and RAB-6.2 have partially redundant functions in overall retrograde transport, but also have their own unique cellular- and subcellular functions. PMID:26891225

  14. [Advances on endoscopic treatment of intestinal fistulas].

    PubMed

    Wu, X W; Ren, J A; Li, J S

    2016-03-01

    Intestinal fistulas are severe complications after abdominal surgical procedures. The endoscopic therapy makes it possible to close fistulas without surgical interventions. When patients achieved stabilization and had no signs of systemic sepsis or inflammation, these therapies could be conducted, which included endoscopic vacuum therapy, fibrin glue sealing, stents, fistula plug, suture, and Over The Scope Clip (OTSC). Various techniques may be combined. Endoscopy vacuum therapy could be applied to control systemic inflammation and prevent continuing septic contamination by active drainage. Endoscopic stent is placed over fistulas and gastrointestinal continuity is recovered. The glue sealing is applied for enterocutaneous fistulas, and endoscopy suture has the best results seen in fistulas <1 cm in diameter. Insertion of the fistula plug is used to facilitate fistula healing. The OTSC is effective to treat leaks with large defects. Endoscopic treatment could avoid reoperation and could be regarded as the first-line treatment for specific patients. PMID:26932894

  15. Local excision by transanal endoscopic surgery

    PubMed Central

    García-Flórez, Luis J; Otero-Díez, Jorge L

    2015-01-01

    Transanal endoscopic surgery (TES) consists of a series of anorectal surgical procedures using different devices that are introduced into the anal canal. TES has been developed significantly since it was first used in the 1980s. The key point for the success of these techniques is how accurately patients are selected. The main indication was the resection of endoscopically unresectable adenomas. In recent years, these techniques have become more widespread which has allowed them to be applied in conservative rectal procedures for both benign diseases and selected cases of rectal cancer. For more advanced rectal cancers it should be considered palliative or, in some controlled trials, experimental. The role of newer endoscopic techniques available has not yet been defined. TES may allow for new strategies in the treatment of rectal pathology, like transanal natural orifice transluminal endoscopic surgery or total mesorectal excision. PMID:26309355

  16. Devices for the endoscopic treatment of hemorrhoids.

    PubMed

    Siddiqui, Uzma D; Barth, Bradley A; Banerjee, Subhas; Bhat, Yasser M; Chauhan, Shailendra S; Gottlieb, Klaus T; Konda, Vani; Maple, John T; Murad, Faris M; Pfau, Patrick; Pleskow, Douglas; Tokar, Jeffrey L; Wang, Amy; Rodriguez, Sarah A

    2014-01-01

    Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative effectiveness, RBL is currently the most widely used technique. PMID:24239254

  17. Recent traction methods for endoscopic submucosal dissection

    PubMed Central

    Tsuji, Kunihiro; Yoshida, Naohiro; Nakanishi, Hiroyoshi; Takemura, Kenichi; Yamada, Shinya; Doyama, Hisashi

    2016-01-01

    Endoscopic mucosal resection (EMR) is problematic with regard to en bloc and curable resection rates. Advancements in endoscopic techniques have enabled novel endoscopic approaches such as endoscopic submucosal dissection (ESD), which has overcome some EMR problems, and has become the standard treatment for gastrointestinal tumors. However, ESD is technically difficult. Procedure time is longer and complications such as intraoperative perforation and bleeding occur more frequently than in EMR. Recently various traction methods have been introduced to facilitate ESD procedures, such as clip with line, external forceps, clip and snare, internal traction, double scope, and magnetic anchor. Each method must be used appropriately according to the anatomical characteristics. In this review we discuss recently proposed traction methods for ESD based on the characteristics of various anatomical sites. PMID:27468186

  18. Esophageal papilloma: Flexible endoscopic ablation by radiofrequency

    PubMed Central

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

    2015-01-01

    Squamous papilloma of the esophagus is a rare benign lesion of the esophagus. Radiofrequency ablation is an established endoscopic technique for the eradication of Barrett esophagus. No cases of endoscopic ablation of esophageal papilloma by radiofrequency ablation (RFA) have been reported. We report a case of esophageal papilloma successfully treated with a single session of radiofrequency ablation. Endoscopic ablation of the lesion was achieved by radiofrequency using a new catheter inserted through the working channel of endoscope. The esophageal ablated tissue was removed by a specifically designed cup. Complete ablation was confirmed at 3 mo by endoscopy with biopsies. This case supports feasibility and safety of as a new potential indication for BarrxTM RFA in patients with esophageal papilloma. PMID:25789102

  19. Advanced endoscopic imaging to improve adenoma detection

    PubMed Central

    Neumann, Helmut; Nägel, Andreas; Buda, Andrea

    2015-01-01

    Advanced endoscopic imaging is revolutionizing our way on how to diagnose and treat colorectal lesions. Within recent years a variety of modern endoscopic imaging techniques was introduced to improve adenoma detection rates. Those include high-definition imaging, dye-less chromoendoscopy techniques and novel, highly flexible endoscopes, some of them equipped with balloons or multiple lenses in order to improve adenoma detection rates. In this review we will focus on the newest developments in the field of colonoscopic imaging to improve adenoma detection rates. Described techniques include high-definition imaging, optical chromoendoscopy techniques, virtual chromoendoscopy techniques, the Third Eye Retroscope and other retroviewing devices, the G-EYE endoscope and the Full Spectrum Endoscopy-system. PMID:25789092

  20. Endoscopic resection of superficial gastrointestinal tumors

    PubMed Central

    Marc, Giovannini; Lopes, Cesar Vivian

    2008-01-01

    Therapeutic endoscopy plays a major role in the management of gastrointestinal (GI) neoplasia. Its indications can be generalized into four broad categories; to remove or obliterate neoplastic lesion, to palliate malignant obstruction, or to treat bleeding. Only endoscopic resection allows complete histological staging of the cancer, which is critical as it allows stratification and refinement for further treatment. Although other endoscopic techniques, such as ablation therapy, may also cure early GI cancer, they can not provide a definitive pathological specimen. Early stage lesions reveal low frequency of lymph node metastasis which allows for less invasive treatments and thereby improving the quality of life when compared to surgery. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are now accepted worldwide as treatment modalities for early cancers of the GI tract. PMID:18698673

  1. Endoscopic treatment of difficult choledocholithiasis.

    PubMed

    Belvedere, B; Frattaroli, S; Carbone, A; Viceconte, G

    2012-05-01

    Common bile duct stones can be treated with normal endoscopic techniques. Where stones cannot be removed due to their size or number or due to stenosis of the common bile duct, a plastic stent can be inserted, enabling rapid drainage of bile. At the three-month check-up complete removal of the stones was found in 41 (85.4%) of the 48 patients with difficult choledocholithiasis. In the remaining 7 patients (14.6%), the stent in any case resulted in clinical improvement. A permanent stent was necessary in 4 patients, enabling safe drainage with no complications. The use of endoscopy for stent placement was effective in all our cases of difficult coledocholithiasis without any complications. PMID:22709458

  2. Retrograde mechanochemical ablation of the small saphenous vein for the treatment of a venous ulcer.

    PubMed

    Moore, Hayley M; Lane, Tristan R A; Franklin, Ian J; Davies, Alun H

    2014-10-01

    We present the first case of retrograde ablation of the small saphenous vein to treat active venous ulceration. A 73-year-old gentleman with complicated varicose veins of the left leg and a non-healing venous ulcer despite previous successful endovenous treatment to his left great saphenous vein underwent mechanochemical ablation of his small saphenous vein with the ClariVein® system, under local anaesthetic, using a retrograde cannulation technique. Post-operatively the patient had improved symptomatically and the ulcer size had reduced. This report highlights that patients with small saphenous vein incompetence and active ulceration can be treated successfully with retrograde mechanochemical ablation. PMID:24347131

  3. TCTEX1D2 mutations underlie Jeune asphyxiating thoracic dystrophy with impaired retrograde intraflagellar transport.

    PubMed

    Schmidts, Miriam; Hou, Yuqing; Cortés, Claudio R; Mans, Dorus A; Huber, Celine; Boldt, Karsten; Patel, Mitali; van Reeuwijk, Jeroen; Plaza, Jean-Marc; van Beersum, Sylvia E C; Yap, Zhi Min; Letteboer, Stef J F; Taylor, S Paige; Herridge, Warren; Johnson, Colin A; Scambler, Peter J; Ueffing, Marius; Kayserili, Hulya; Krakow, Deborah; King, Stephen M; Beales, Philip L; Al-Gazali, Lihadh; Wicking, Carol; Cormier-Daire, Valerie; Roepman, Ronald; Mitchison, Hannah M; Witman, George B

    2015-01-01

    The analysis of individuals with ciliary chondrodysplasias can shed light on sensitive mechanisms controlling ciliogenesis and cell signalling that are essential to embryonic development and survival. Here we identify TCTEX1D2 mutations causing Jeune asphyxiating thoracic dystrophy with partially penetrant inheritance. Loss of TCTEX1D2 impairs retrograde intraflagellar transport (IFT) in humans and the protist Chlamydomonas, accompanied by destabilization of the retrograde IFT dynein motor. We thus define TCTEX1D2 as an integral component of the evolutionarily conserved retrograde IFT machinery. In complex with several IFT dynein light chains, it is required for correct vertebrate skeletal formation but may be functionally redundant under certain conditions. PMID:26044572

  4. TCTEX1D2 mutations underlie Jeune asphyxiating thoracic dystrophy with impaired retrograde intraflagellar transport

    PubMed Central

    Schmidts, Miriam; Hou, Yuqing; Cortés, Claudio R.; Mans, Dorus A.; Huber, Celine; Boldt, Karsten; Patel, Mitali; van Reeuwijk, Jeroen; Plaza, Jean-Marc; van Beersum, Sylvia E. C.; Yap, Zhi Min; Letteboer, Stef J. F.; Taylor, S. Paige; Herridge, Warren; Johnson, Colin A.; Scambler, Peter J.; Ueffing, Marius; Kayserili, Hulya; Krakow, Deborah; King, Stephen M.; Beales, Philip L.; Al-Gazali, Lihadh; Wicking, Carol; Cormier-Daire, Valerie; Roepman, Ronald; Mitchison, Hannah M.; Witman, George B.; Al-Turki, Saeed; Anderson, Carl; Anney, Richard; Antony, Dinu; Asimit, Jennifer; Ayub, Mohammad; Barrett, Jeff; Barroso, Inês; Bentham, Jamie; Bhattacharya, Shoumo; Blackwood, Douglas; Bobrow, Martin; Bochukova, Elena; Bolton, Patrick; Boustred, Chris; Breen, Gerome; Brion, Marie-Jo; Brown, Andrew; Calissano, Mattia; Carss, Keren; Chatterjee, Krishna; Chen, Lu; Cirak, Sebhattin; Clapham, Peter; Clement, Gail; Coates, Guy; Collier, David; Cosgrove, Catherine; Cox, Tony; Craddock, Nick; Crooks, Lucy; Curran, Sarah; Daly, Allan; Danecek, Petr; Smith, George Davey; Day-Williams, Aaron; Day, Ian; Durbin, Richard; Edkins, Sarah; Ellis, Peter; Evans, David; Farooqi, I. Sadaf; Fatemifar, Ghazaleh; Fitzpatrick, David; Flicek, Paul; Floyd, Jamie; Foley, A. Reghan; Franklin, Chris; Futema, Marta; Gallagher, Louise; Gaunt, Tom; Geschwind, Daniel; Greenwood, Celia; Grozeva, Detelina; Guo, Xiaosen; Gurling, Hugh; Hart, Deborah; Hendricks, Audrey; Holmans, Peter; Huang, Jie; Humphries, Steve E.; Hurles, Matt; Hysi, Pirro; Jackson, David; Jamshidi, Yalda; Jewell, David; Chris, Joyce; Kaye, Jane; Keane, Thomas; Kemp, John; Kennedy, Karen; Kent, Alastair; Kolb-Kokocinski, Anja; Lachance, Genevieve; Langford, Cordelia; Lee, Irene; Li, Rui; Li, Yingrui; Ryan, Liu; Lönnqvist, Jouko; Lopes, Margarida; MacArthur, Daniel G.; Massimo, Mangino; Marchini, Jonathan; Maslen, John; McCarthy, Shane; McGuffin, Peter; McIntosh, Andrew; McKechanie, Andrew; McQuillin, Andrew; Memari, Yasin; Metrustry, Sarah; Min, Josine; Moayyeri, Alireza; Morris, James; Muddyman, Dawn; Muntoni, Francesco; Northstone, Kate; O'Donovan, Michael; O'Rahilly, Stephen; Onoufriadis, Alexandros; Oualkacha, Karim; Owen, Michael; Palotie, Aarno; Panoutsopoulou, Kalliope; Parker, Victoria; Parr, Jeremy; Paternoster, Lavinia; Paunio, Tiina; Payne, Felicity; Perry, John; Pietilainen, Olli; Plagnol, Vincent; Quail, Michael A.; Quaye, Lydia; Raymond, Lucy; Rehnström, Karola; Brent Richards, J.; Ring, Sue; Ritchie, Graham R S; Savage, David B.; Schoenmakers, Nadia; Semple, Robert K.; Serra, Eva; Shihab, Hashem; Shin, So-Youn; Skuse, David; Small, Kerrin; Smee, Carol; Soler, Artigas María; Soranzo, Nicole; Southam, Lorraine; Spector, Tim; St Pourcain, Beate; St. Clair, David; Stalker, Jim; Surdulescu, Gabriela; Suvisaari, Jaana; Tachmazidou, Ioanna; Tian, Jing; Timpson, Nic; Tobin, Martin; Valdes, Ana; van Kogelenberg, Margriet; Vijayarangakannan, Parthiban; Wain, Louise; Walter, Klaudia; Wang, Jun; Ward, Kirsten; Wheeler, Ellie; Whittall, Ros; Williams, Hywel; Williamson, Kathy; Wilson, Scott G.; Wong, Kim; Whyte, Tamieka; ChangJiang, Xu; Zeggini, Eleftheria; Zhang, Feng; Zheng, Hou-Feng

    2015-01-01

    The analysis of individuals with ciliary chondrodysplasias can shed light on sensitive mechanisms controlling ciliogenesis and cell signalling that are essential to embryonic development and survival. Here we identify TCTEX1D2 mutations causing Jeune asphyxiating thoracic dystrophy with partially penetrant inheritance. Loss of TCTEX1D2 impairs retrograde intraflagellar transport (IFT) in humans and the protist Chlamydomonas, accompanied by destabilization of the retrograde IFT dynein motor. We thus define TCTEX1D2 as an integral component of the evolutionarily conserved retrograde IFT machinery. In complex with several IFT dynein light chains, it is required for correct vertebrate skeletal formation but may be functionally redundant under certain conditions. PMID:26044572

  5. Retrograde Proximal Anterior Tibial Artery Access for Treating Femoropopliteal Segment Occlusion: A Novel Approach.

    PubMed

    Affonso, Breno Boueri; Golghetto Domingos, Fernanda Uchiyama; da Motta Leal Filho, Joaquim Maurício; Maciel, Macello José Sampaio; Cavalcante, Rafael Noronha; Bortolini, Edgar; Carnevale, Francisco Cesar

    2016-05-01

    Some challenges have been detected when there are long and complex lesions of femoropopliteal arterial occlusive disease, even with descriptions of the retrograde pedal approaches. The aim of this article is to describe the retrograde proximal anterior tibial artery access for treatment of femoropopliteal segment occlusion when antegrade recanalization failed (retrograde recanalization and rearranging the system into an antegrade position). Technical and clinical success was achieved in 100% of 4 cases, with an improvement of at least 2 Rutherford classes. Minor complication, small hematoma in an anterior compartment of the limb, occurred in 1 patient. No sign of compartmental syndrome was observed. PMID:26902943

  6. Survey of Endoscope Reprocessing in Korea

    PubMed Central

    Park, Jeong Bae; Yang, Jae Nam; Koo, Ja Seol; Jang, Jae Young; Park, Sang Hoon; Hong, Su Jin; Kim, Sang-Woo; Chun, Hoon Jai

    2015-01-01

    Background/Aims There is a growing emphasis on quality management in endoscope reprocessing. Previous surveys conducted in 2002 and 2004 were not practitioner-oriented. Therefore, this survey is significant for being the first to target actual participants in endoscope reprocessing in Korea. Methods This survey comprised 33 self-filled questions, and was personally delivered to nurses and nursing auxiliaries in the endoscopy departments of eight hospitals belonging to the society. The anonymous responses were collected after 1 week either by post or in person by committee members. Results The survey included 100 participants. In the questionnaire addressing compliance rates with the reprocessing guideline, the majority (98.9%) had a high compliance rate compared to 27% of respondents in 2002 and 50% in 2004. The lowest rate of compliance with a reprocessing procedure was reported for transporting the contaminated endoscope in a sealed container. Automated endoscope reprocessors were available in all hospitals. Regarding reprocessing time, more than half of the subjects replied that reprocessing took more than 15 minutes (63.2%). Conclusions The quality management of endoscope reprocessing has improved as since the previous survey. A national survey expanded to include primary clinics is required to determine the true current status of endoscope reprocessing. PMID:25674525

  7. Forehead Mass Removal by Endoscopic Approach.

    PubMed

    Jung, Soyeon; Jung, Sung Won; Koh, Sung Hoon; Lim, Hyoseob

    2016-03-01

    Patients with forehead mass have a cosmetic problem because the forehead is an important first impression. Conventional skin approach results in visible scar even though surgeons designed the incision along the relaxed skin tension line1. Since Onishi introduced the technique for endoscopic approach in 1995, endoscopic surgery has become rapidly popular in the field of plastic surgery. Endoscopic approach to the forehead mass by small incision on the scalp behind hair line is big advantageous for leaving less ugly scar on the forehead. All procedures need to be identified under the endoscopic visualization. When it was completed, the mass was pulled out. The authors also used the osteotome or rasp when it was the osteoma. The forehead and scalp were applied compressive dressing to prevent hematoma and swelling for 2 days. The cosmesis was excellent because they have no visible scar on the forehead. Endoscopic approaching technique is getting popular and commonly used during the cosmetic surgery because it has many advantages. This method also, however, has difficulties to remove large-sized mass and to perform caudal dissection, and for increased operative times. Furthermore, there are complication of incomplete removal, hematoma, and swelling. The proper candidate is the patient with smooth forehead, with a mobile and soft mass, with a propensity for keloid formation, or hypertrophic scarring. Endoscopic technique is not only advantageous but also disadvantageous. That is why surgeon's selection is more important. PMID:26967101

  8. Transoral endoscopic thyroidectomy: A case report

    PubMed Central

    Pai, Vishwanath M.; Muthukumar, Pari; Prathap, Apoorva; Leo, Jayanth; A., Rekha

    2015-01-01

    Introduction Endoscopic thyroidectomy, initially an experimental procedure, is now being performed in increasing frequency. It aims to provide patients undergoing thyroidectomy with a ‘scar-free’ surgery. Transoral endoscopic thyroidectomy is one such novel procedure that is based on the principles of natural orifice translumenal surgery (NOTES) and allows for a truly scar-free surgery with minimal dissection. Presentation of case A 21-year-old female presented with a swelling over the left side of her neck. Ultrasound revealed a solitary nodule and FNAC showed features suggestive of a follicular adenoma. Discussion The patient underwent transoral endoscopic hemi-thyroidectomy. The procedure lasted for 2 h and is one of the few documented cases of transoral endoscopic thyroidectomy performed on live patients. Conclusion Transoral endoscopic thyroidectomy is proving to be a feasible technique with little or no complications as compared to other endoscopic thyroid surgeries. It provides surgeons with easy access to the thyroid gland and patients with aesthetically pleasing results. PMID:26048629

  9. Endoscopically assisted excision of digital enchondroma.

    PubMed

    Dietz, Jeffrey F; Kachar, Sergey M; Nagle, Daniel J

    2007-06-01

    We present 2 cases of endoscopically assisted curettage of enchondroma of the hand. After initial open curettage of the lesion, a 1.9-mm arthroscope was introduced through a small cortical window. Under arthroscopic guidance, residual pathologic material was freed from the cavity wall and evacuated with the aid of repeated saline lavage combined with suction. The saline was injected through an 18-gauge angiocatheter under direct endoscopic control. The endoscope was then used to observe the filling of the cavity with demineralized bone matrix (DBX; Synthes [USA], Paoli, PA). We believe that endoscopically assisted curettage presents several advantages over open curettage alone. First, direct visualization of the medullary canal permits accurate assessment of the extent of the enchondroma. Second, the endoscope permits accurate assessment of the adequacy of the curettage, thus avoiding the need to perform multiple, blind, and aggressive passes with a curette. Multiple passes can increase the risk of violation of the cortical shell and can prolong the procedure. Third, the ability to completely clear the medullary canal of all tumors should logically reduce the rate of recurrence. In conclusion, the addition of an endoscope is an inexpensive modification that promises to save time, decrease morbidity, and possibly improve long-term outcomes. PMID:17560488

  10. Application of endoscopic techniques in orbital blowout fractures.

    PubMed

    Zhang, Shu; Li, Yinwei; Fan, Xianqun

    2013-09-01

    Minimally invasive surgical techniques, particularly endoscopic techniques, have revolutionized otolaryngeal surgery. Endoscopic techniques have been gradually applied in orbital surgery through the sinus inferomedial to the orbit and the orbital subperiosteal space. Endoscopic techniques help surgeons observe fractures and soft tissue of the posterior orbit to precisely place implants and protect vital structures through accurate, safe, and minimally invasive approaches. We reviewed the development of endoscopic techniques, the composition of endoscopic systems for orbital surgery, and the problems and developmental prospects of endoscopic techniques for simple orbital wall fracture repair. PMID:23794028

  11. Endoscopic ultrasound (EUS)-guided transhepatic anterograde self-expandable metal stent (SEMS) placement across malignant biliary obstruction.

    PubMed

    Nguyen-Tang, T; Binmoeller, K F; Sanchez-Yague, A; Shah, J N

    2010-03-01

    Endoscopic retrograde cholangiopancreatography (ERCP) with placement of self-expandable metal stents (SEMS) for palliation of malignant obstruction may not be possible in patients with an inaccessible biliary orifice. Endoscopic ultrasound (EUS)-guided drainage methods may be useful in this setting. This study aimed to determine the outcomes of EUS-guided anterograde SEMS placement across malignant strictures in patients with an inaccessible biliary orifice. Over a 2-year period, procedural and outcomes data on all patients undergoing EUS-guided anterograde SEMS drainage after failed ERCP were prospectively entered into a database and reviewed. Five patients underwent EUS-guided anterograde SEMS. Indications included: advanced pancreatic cancer (n = 3), metastatic cancer (n = 1), and anastomotic stricture (n = 1). The biliary orifice could not be reached endoscopically due to duodenal stricture (n = 4) or inaccessible hepaticojejunostomy (n = 1). EUS-guided punctures were performed transgastrically into left intrahepatic ducts (n = 4) or transbulbar into the common bile duct (n = 1). Guide wires were passed and SEMS were successfully deployed across strictures in an anterograde fashion in all patients. Jaundice resolved and serum bilirubin levels decreased in all cases. No procedure-related complications were noted during a mean follow-up of 9.2 months. EUS-guided anterograde SEMS placement appears to be a safe and efficient technique for palliation of biliary obstruction in patients with an endoscopically inaccessible biliary orifice. The procedure can be performed at the time of failed standard ERCP, and provides an alternative drainage option to percutaneous or surgical decompression and to EUS-guided creation of bilioenteric fistulae. PMID:20119894

  12. Air cholangiography in endoscopic bilateral stent-in-stent placement of metallic stents for malignant hilar biliary obstruction

    PubMed Central

    Lee, Jae Min; Lee, Sang Hyub; Jang, Dong Kee; Chung, Kwang Hyun; Park, Jin Myung; Paik, Woo Hyun; Lee, Jun Kyu; Ryu, Ji Kon; Kim, Yong-Tae

    2016-01-01

    Background: Although endoscopic bilateral stent-in-stent (SIS) placement of self-expandable metallic stents (SEMS) is one of the major palliative treatments for unresectable malignant hilar biliary obstruction, post-endoscopic retrograde cholangiopancreatography (ERCP) cholangitis can occur frequently due to inadequate drainage, especially after contrast injection into the biliary tree. The aim of this study is to evaluate the efficacy and safety of air cholangiography-assisted stenting. Methods: This study included 47 patients with malignant hilar biliary obstruction who underwent endoscopic bilateral SEMS placement using the SIS technique. They were divided into two groups, air (n = 23) or iodine contrast (n = 24) cholangiography. We retrospectively compared comprehensive clinical and laboratory data of both groups. Results: There were no significant differences found between the two groups with respect to technical success (87% versus 87.5%, air versus contrast group, respectively), functional success (95% versus 95.2%), 30-day mortality (8.3% versus 8.7%) and stent patency. Post-ERCP adverse events occurred in 5 (21.7%) of the patients in the air group and 8 (33.3%) of the patients in the contrast group. Among these, the rate of cholangitis was significantly lower in the air group (4.8% versus 29.2%, p = 0.048). In multivariate analysis, air cholangiography, technical success and a shorter procedure time were significantly associated with a lower incidence of post-ERCP cholangitis. Conclusions: Air cholangiography-assisted stenting can be a safe and effective method for endoscopic bilateral SIS placement of SEMS in patients with malignant hilar biliary obstruction. PMID:26929781

  13. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection.

    PubMed

    Yoshida, Naohisa; Fernandopulle, Nilesh; Inada, Yutaka; Naito, Yuji; Itoh, Yoshito

    2014-09-01

    Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments. PMID:25102984

  14. Yeast as a tool to study mitochondrial retrograde pathway en route to cell stress response.

    PubMed

    Ždralević, Maša; Guaragnella, Nicoletta; Giannattasio, Sergio

    2015-01-01

    Mitochondrial retrograde signaling is a mitochondria-to-nucleus communication pathway, conserved from yeast to humans, by which dysfunctional mitochondria relay signals that lead to cell stress adaptation in physiopathological conditions by changes in nuclear gene expression. The best comprehension of components and regulation of retrograde signaling have been obtained in Saccharomyces cerevisiae, where retrograde target gene expression is regulated by RTG genes. In this chapter, we describe the methods to measure mitochondrial retrograde pathway activation in yeast cells by monitoring the mRNA levels of RTG target genes, such as those encoding for peroxisomal citrate synthase, aconitase, and NAD(+)-specific isocitrate dehydrogenase subunit 1, as well as the phosphorylation status of Rtg1/3p transcriptional factor which controls RTG target gene transcription. PMID:25634284

  15. Retrograde Transvenous Ethanol Embolization of High-flow Peripheral Arteriovenous Malformations

    SciTech Connect

    Linden, Edwin van der; Baalen, Jary M. van; Pattynama, Peter M. T.

    2012-08-15

    Purpose: To report the clinical efficiency and complications in patients treated with retrograde transvenous ethanol embolization of high-flow peripheral arteriovenous malformations (AVMs). Retrograde transvenous ethanol embolization of high-flow AVMs is a technique that can be used to treat AVMs with a dominant outflow vein whenever conventional interventional procedures have proved insufficient. Methods: This is a retrospective study of the clinical effectiveness and complications of retrograde embolization in five patients who had previously undergone multiple arterial embolization procedures without clinical success. Results: Clinical outcomes were good in all patients but were achieved at the cost of serious, although transient, complications in three patients. Conclusion: Retrograde transvenous ethanol embolization is a highly effective therapy for high-flow AVMs. However, because of the high complication rate, it should be reserved as a last resort, to be used after conventional treatment options have failed.

  16. Reducing retrogradation and lipid oxidation of normal and glutinous rice flours by adding mango peel powder.

    PubMed

    Siriamornpun, Sirithon; Tangkhawanit, Ekkarat; Kaewseejan, Niwat

    2016-06-15

    Green and ripe mango peel powders (MPP) were added to normal rice flour (NRF) and glutinous rice flour (GRF) at three levels (400, 800 and 1200 ppm) and their effects on physicochemical properties and lipid oxidation inhibition were investigated. Overall, MPP increased the breakdown viscosity and reduced the final viscosity in rice flours when compared to the control. Decreasing in retrogradation was observed in both NRF and GRF with MPP added of all levels. MPP addition also significantly inhibited the lipid oxidation of all flours during storage (30 days). Retrogradation values were strongly negatively correlated with total phenolic and flavonoid contents, but not with fiber content. The hydrogen bonds and hydrophilic interactions between phenolic compounds with amylopectin molecule may be involved the decrease of starch retrogradation, especially GRF. We suggest that the addition of MPP not only reduced the retrogradation but also inhibited the lipid oxidation of rice flour. PMID:26868561

  17. PULMONARY IMPEDANCE IN DOGS MEASURED BY FORCED RANDOM NOISE WITH A RETROGRADE CATHETER

    EPA Science Inventory

    Retrograde catheter and forced random noise techniques were combined to study the distribution of resistance and compliance in dogs following the inhalation of aerosols containing 2.5 and 5.0 mg/ml of histamine.

  18. NGF-stimulated retrograde transport of trkA in the mammalian nervous system.

    PubMed

    Ehlers, M D; Kaplan, D R; Price, D L; Koliatsos, V E

    1995-07-01

    The present study was designed to clarify the in vivo function of trkA as an NGF receptor in mammalian neurons. Using the rat sciatic nerve as a model system, we examined whether trkA is retrogradely transported and whether transport is influenced by physiological manipulations. Following nerve ligation, trkA protein accumulates distal to the ligation site as shown by Western blot analysis. The distally accumulating trkA species were tyrosine phosphorylated. The trkA retrograde transport and phosphorylation were enhanced by injecting an excess of NGF in the footpad and were abolished by blocking endogenous NGF with specific antibodies. These results provide evidence that, upon NGF binding, trkA is internalized and retrogradely transported in a phosphorylated state, possibly together with the neurotrophin. Furthermore, our results suggest that trkA is a primary retrograde NGF signal in mammalian neurons in vivo. PMID:7540615

  19. Fundamental studies of retrograde reactions in direct liquefaction. Topical report, September 30, 1988--September 30, 1989

    SciTech Connect

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

    1989-12-31

    Most of the proposed processing schemes for improving liquefaction yields involve favoring bond-breaking and radical stabilization reactions over the retrograde reactions. The retrograde reactions are often encountered before liquefaction temperatures are reached. The objective of this program is to elucidate and model the retrograde reaction chemistry in direct coal liquefaction through the application of experimental techniques and theoretical models which have been successfully employed at Advanced Fuel Research (AFR) and SRI International (a subcontractor) to understand and predict coal reaction behavior. The study of retrograde reactions is being done using an integrated approach using extensive characterization of the liquefaction chemistry of three kinds of systems: (1) model polymers; (2) coal; and (3) modified coals.

  20. Retrograde signalling at the synapse: a role for Wnt proteins.

    PubMed

    Salinas, P C

    2005-12-01

    The formation of functional synapses requires a proper dialogue between incoming axons and their future synaptic targets. As axons approach their target, they are instructed to slow down and remodel to form proper presynaptic terminals. Although significant progress has been made in the identification of the mechanisms that control axon guidance, little is known about the mechanisms that regulate the conversion of actively growing axon into a presynaptic terminal. We found that Wnt secreted proteins are retrograde signals that regulate the terminal arborization of axons and synaptic differentiation. Wnts released from postsynaptic neurons induce extensive remodelling on incoming axons. This remodelling is manifested by a decrease in axon extension with a concomitant increase in growth-cone size. This morphological change is correlated with changes in the dynamics and organization of microtubules. Studies of a vertebrate synapse and the Drosophila neuromuscular junction suggest that a conserved Wnt signalling pathway modulates presynaptic microtubules as axons remodel during synapse formation. In this paper I discuss the role of the Wnt-Dvl (Dishevelled protein)-GSK-3beta (glycogen synthase kinase-3beta) signalling pathway in axon remodelling during synapse formation in the central nervous system. PMID:16246102

  1. Model for how retrograde actin flow regulates adhesion traction stresses.

    PubMed

    Li, Ying; Bhimalapuram, Prabhakar; Dinner, Aaron R

    2010-05-19

    Cells from animals adhere to and exert mechanical forces on their surroundings. Cells must control these forces for many biological processes, and dysfunction can lead to pathologies. How the actions of molecules within a cell are coordinated to regulate the adhesive interaction with the extracellular matrix remains poorly understood. It has been observed that cytoplasmic proteins that link integrin cell-surface receptors with the actin cytoskeleton flow with varying rates from the leading edge toward the center of a cell. Here, we explore theoretically how measurable subcellular traction stresses depend on the local speed of retrograde actin flow. In the model, forces result from the stretching of molecular complexes in response to the drag from the flow; because these complexes break with extension-dependent kinetics, the flow results in a decrease in their number when sufficiently large. Competition between these two effects naturally gives rise to a clutch-like behavior and a nonmonotonic trend in the measured stresses, consistent with recent data for epithelial cells. We use this basic framework to evaluate slip and catch bond mechanisms for integrins; better fits of experimental data are obtained with a catch bond representation. Extension of the model to one comprising multiple molecular interfaces shifts the peak stress to higher speeds. Connections to other models and cell movement are discussed. PMID:21386439

  2. Early Results of Retrograde Transpopliteal Angioplasty of Iliofemoral Lesions

    SciTech Connect

    Saha, Saumitra; Gibson, Matthew; Magee, Timothy R.; Galland, Robert B.; Torrie, E. Peter H.

    2001-12-15

    Purpose: To assess whether the retrograde transpopliteal approach is a safe, practical and effective alternative to femoral puncture for percutaneous transluminal angioplasty (PTA).Methods: Forty PTAs in 38 patients were evaluated. Intentional subintimal recanalization was performed in 13 limbs. Ultrasound evaluation of the popliteal fossa was carried out 30 min and 24 hr post procedurally in the first 10 patients to exclude local complications. All patients had a follow-up of at least 6 weeks.Results: The indication for PTA was critical ischemia in seven limbs and disabling claudication in the remainder.Stenoses (single or multiple) were present in 24 and occlusion in 15.The superficial femoral artery (SFA) was the commonest segment affected(36) followed by common femoral artery (CFA) in four and iliac artery in four. Technical success was achieved in 38 of 39 limbs where angioplasty was carried out. In one limb no lesion was found.Immediate complications were distal embolization in two and thrombosis in one. None of these required immediate surgery. There were no puncture site hematomas or popliteal arteriovenous fistulae.Symptomatic patency at 6 weeks was 85%. Further reconstructive surgery was required in three limbs and amputation in two.Conclusion: The transpopliteal approach has a high technical success rate and a low complication rate with a potential to develop into an outpatient procedure. It should be considered for flush SFA occulsions or iliac disease with tandem CFA/SFA disease where the contralateral femoral approach is often technically difficult.

  3. Retrograde heart perfusion: the Langendorff technique of isolated heart perfusion.

    PubMed

    Bell, Robert M; Mocanu, Mihaela M; Yellon, Derek M

    2011-06-01

    In the late 19th century, a number of investigators were working on perfecting isolated heart model, but it was Oscar Langendorff who, in 1895, pioneered the isolated perfused mammalian heart. Since that time, the Langendorff preparation has evolved and provided a wealth of data underpinning our understanding of the fundamental physiology of the heart: its contractile function, coronary blood flow regulation and cardiac metabolism. In more recent times, the procedure has been used to probe pathophysiology of ischaemia/reperfusion and disease states, and with the dawn of molecular biology and genetic manipulation, the Langendorff perfused heart has remained a stalwart tool in the study of the impact upon the physiology of the heart by pharmacological inhibitors and targeted deletion or up-regulation of genes and their impact upon intracellular signalling and adaption to clinically relevant stressful stimuli. We present here the basic structure of the Langendorff system and the fundamental experimental rules which warrant a viable heart preparation. In addition, we discuss the use of the isolated retrograde perfused heart in the model of ischaemia-reperfusion injury ex-vivo, and its applicability to other areas of study. The Langendorff perfusion apparatus is highly adaptable and this is reflected not only in the procedure's longevity but also in the number of different applications to which it has been turned. PMID:21385587

  4. Retrograde amnesia in praying mantis after two successive learning processes.

    PubMed

    Zabala, N A; Maldonado, H

    1990-01-01

    Learning and memory consolidation was investigated in the mantis Stagmatoptera biocellata, by two successive trainings: a) the attack (A) avoidance training in which animals were not allowed to catch a mobile star, followed by the deimatic reaction (DR) avoidance training of not displaying this defensive response, or b) DR-avoidance training followed by A-avoidance training. The results showed that the presence and the 1 of A-avoidance learning and DR-avoidance learning did not affect the learning of the other training. Total retention of A-avoidance memory was demonstrated when A-avoidance training was given first, whereas DR-avoidance memory was significantly lost (716%) when the DR-avoidance training was given first. The retroactive forgetting of DR-avoidance memory is considered as retrograde amnesia rather than retroactive memory inhibition because it depends on the activity during A-avoidance training (number of attacks) and not the quantity of A-avoidance learning. The magnitude of the amnesic effect due to this distracting activity in the A-avoidance training appears to be remarkably similar to that reported in a previous work using nitrogen-induced anoxia as the amnesic factor. PMID:2152377

  5. Retrograde root filling with dentin-bonded modified resin composite.

    PubMed

    Rud, J; Rud, V; Munksgaard, E C

    1996-09-01

    A retrograde root-end cover with a special resin composite (Retroplast) combined with the dentin bonding agent Gluma (Bayer AG) has been used since 1984 by the authors. Its content of silver, added to promote radiopacity, has been found to lower the working time and storage stability of the composite and might cause discolorations. Since 1990, silver has therefore been replaced with ytterbium trifluoride, which eliminates these side effects. The purpose of this study was to compare the clinical results obtained with these two resin composites and to evaluate the healing results after several years in function. Apical fillings (351) with the modified Retroplast showed the following radiographic healing pattern 1 yr after surgery: 80% complete healing, 2% scar tissue, 12% uncertain healing, and 6% failure. No significant difference in this healing pattern was found, compared with that obtained with the silver-containing Retroplast. Cases with ytterbium trifluoride classified as scar tissue and uncertain healing at 1 yr when examined at 2 to 4 yr postoperatively showed 89% complete healing. 0% scar tissue, 1% uncertain healing, and 9% failure. This result is significantly different from that obtained 1 yr after surgery. Based on calculations, it was predicted that with time 90% will become complete healing, whereas 10% will become failure. PMID:9198430

  6. Posterior tibial artery access using transradial techniques: retrograde approach to inaccessible lower extremity lesions.

    PubMed

    Londoño, Juan Carlos; Singh, Vikas; Martinez, Claudia A

    2012-06-01

    Percutaneous intervention of chronic limb ischemia is often limited by vascular access especially in patients with previous surgical interventions. This warrants development of alternative endovascular techniques, particularly for patients in whom traditional ipsilateral antegrade or contralateral retrograde access has failed or is not possible. We describe a novel approach to the posterior tibial artery using retrograde access with transradial techniques including closure devices in two patients with inaccessible antegrade access. PMID:21432983

  7. Emergent retrograde tracheal intubation in a 3-year-old with stevens-johnsons syndrome.

    PubMed

    He, Michael

    2014-01-01

    A 3-year-old girl suffering from Stevens-Johnsons Syndrome with severe sloughing of the oropharyngeal mucosa was brought to the operating room for an emergent tracheostomy after multiple failed attempts to intubate the trachea in the pediatric intensive care unit. However, a retrograde tracheal intubation was successfully performed in the operating room to secure her airway, after which a tracheostomy was performed. Retrograde intubation can be a quick and effective method for securing the difficult airway. PMID:25612259

  8. Retrograde solubility of formamidinium and methylammonium lead halide perovskites enabling rapid single crystal growth.

    PubMed

    Saidaminov, Makhsud I; Abdelhady, Ahmed L; Maculan, Giacomo; Bakr, Osman M

    2015-12-28

    Here we show the retrograde solubility of various hybrid perovskites through the correct choice of solvent(s) and report their solubility curves. Retrograde solubility enables to develop inverse temperature crystallization of FAPbX3 (FA = HC(NH2)2(+), X = Br(-)/I(-)). FAPbI3 crystals exhibit a 1.4 eV bandgap--considerably narrower than their polycrystalline counterparts. PMID:26511771

  9. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  10. Local translation and retrograde axonal transport of CREB regulates IL-6-induced nociceptive plasticity

    PubMed Central

    2014-01-01

    Transcriptional regulation of genes by cyclic AMP response element binding protein (CREB) is essential for the maintenance of long-term memory. Moreover, retrograde axonal trafficking of CREB in response to nerve growth factor (NGF) is critical for the survival of developing primary sensory neurons. We have previously demonstrated that hindpaw injection of interleukin-6 (IL-6) induces mechanical hypersensitivity and hyperalgesic priming that is prevented by the local injection of protein synthesis inhibitors. However, proteins that are locally synthesized that might lead to this effect have not been identified. We hypothesized that retrograde axonal trafficking of nascently synthesized CREB might link local, activity-dependent translation to nociceptive plasticity. To test this hypothesis, we determined if IL-6 enhances the expression of CREB and if it subsequently undergoes retrograde axonal transport. IL-6 treatment of sensory neurons in vitro caused an increase in CREB protein and in vivo treatment evoked an increase in CREB in the sciatic nerve consistent with retrograde transport. Importantly, co-injection of IL-6 with the methionine analogue azido-homoalanine (AHA), to assess nascently synthesized proteins, revealed an increase in CREB containing AHA in the sciatic nerve 2 hrs post injection, indicating retrograde transport of nascently synthesized CREB. Behaviorally, blockade of retrograde transport by disruption of microtubules or inhibition of dynein or intrathecal injection of cAMP response element (CRE) consensus sequence DNA oligonucleotides, which act as decoys for CREB DNA binding, prevented the development of IL-6-induced mechanical hypersensitivity and hyperalgesic priming. Consistent with previous studies in inflammatory models, intraplantar IL-6 enhanced the expression of BDNF in dorsal root ganglion (DRG). This effect was blocked by inhibition of retrograde axonal transport and by intrathecal CRE oligonucleotides. Collectively, these findings

  11. Successful Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varix Mainly Draining into the Pericardiophrenic Vein

    SciTech Connect

    Kageyama, Ken; Nishida, N. Matsui, H.; Yamamoto, A.; Nakamura, K.; Miki, Y.

    2012-02-15

    Two cases of gastric varices were treated by balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein at our hospital, and both were successful. One case developed left hydrothorax. Gastric varices did not bled and esophageal varices were not aggravated in both cases for 24-30 months thereafter. These outcomes indicate the feasibility of balloon-occluded retrograde transvenous obliteration via the pericardiophrenic vein.

  12. Navigation system for flexible endoscopes

    NASA Astrophysics Data System (ADS)

    Hummel, Johann; Figl, Michael; Birkfellner, Wolfgang; Häfner, Michael; Kollmann, Christian; Bergmann, Helmar

    2003-05-01

    Endoscopic Ultrasound (EUS) features flexible endoscopes equipped with a radial or linear array scanhead allowing high resolution examination of organs adjacent to the upper gastrointestinal tract. An optical system based on fibre-glass or a CCD-chip allows additional orientation. However, 3-dimensional orientation and correct identification of the various anatomical structures may be difficult. It therefore seems desirable to merge real-time US images with high resolution CT or MR images acquired prior to EUS to simplify navigation during the intervention. The additional information provided by CT or MR images might facilitate diagnosis of tumors and, ultimately, guided puncture of suspicious lesions. We built a grid with 15 plastic spheres and measured their positions relatively to five fiducial markers placed on the top of the grid. For this measurement we used an optical tracking system (OTS) (Polaris, NDI, Can). Two sensors of an electromagnetic tracking system (EMTS) (Aurora, NDI, Can) were mounted on a flexible endoscope (Pentax GG 38 UX, USA) to enable a free hand ultrasound calibration. To determine the position of the plastic spheres in the emitter coordinate system of the EMTS we applied a point-to-point registration (Horn) using the coordinates of the fiducial markers in both coordinate systems (OTS and EMTS). For the transformation between EMTS to the CT space the Horn algorithm was adopted again using the fiducial markers. Visualization was enabled by the use of the AVW-4.0 library (Biomedical Imaging Resource, Mayo Clinic, Rochester/MN, USA). To evaluate the suitability of our new navigation system we measured the Fiducial Registration Error (FRE) of the diverse registrations and the Target Registration Error (TRE) for the complete transformation from the US space to the CT space. The FRE for the ultrasound calibration amounted to 4.3 mm +/- 4.2 mm, resulting from 10 calibration procedures. For the transformation from the OTS reference system to the

  13. Endoscopic resection of colorectal granular cell tumors

    PubMed Central

    Take, Iri; Shi, Qiang; Qi, Zhi-Peng; Cai, Shi-Lun; Yao, Li-Qing; Zhou, Ping-Hong; Zhong, Yun-Shi

    2015-01-01

    AIM: To determine the feasibility and effectiveness of endoscopic resection for the treatment of colorectal granular cell tumors (GCTs). METHODS: This was a retrospective study performed at a single institution. From January 2008 to April 2015, we examined a total of 11 lesions in 11 patients who were treated by an endoscopic procedure for colorectal GCTs in the Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China. Either endoscopic mucosal resection or endoscopic submucosal dissection (ESD) was performed by three surgeons with expertise in endoscopic treatment. The pre- and post-operative condition and follow-up of these patients were evaluated by colonoscopy and endoscopic ultrasonography (EUS). RESULTS: Of these 11 lesions, 2 were located in the cecum, 3 were in the ileocecal junction, 5 were in the ascending colon, and 1 was in the rectum. The median maximum diameter of the tumors was 0.81 cm (range 0.4-1.2 cm). The en bloc rate was 100%, and the complete resection rate was 90.9% (10/11). Post-operative pathology in one patient showed a tumor at the cauterization margin. However, during ESD, this lesion was removed en bloc, and no tumor tissue was seen in the wound. No perforations or delayed perforations were observed and emergency surgery was not required for complications. All patients were followed up to May 2015, and none had recurrence, metastasis, or complaints of discomfort. CONCLUSION: Endoscopic treatment performed by endoscopists with sufficient experience appears to be feasible and effective for colorectal GCTs. PMID:26730166

  14. Endoscopic video manifolds for targeted optical biopsy.

    PubMed

    Atasoy, Selen; Mateus, Diana; Meining, Alexander; Yang, Guang-Zhong; Navab, Nassir

    2012-03-01

    Gastro-intestinal (GI) endoscopy is a widely used clinical procedure for screening and surveillance of digestive tract diseases ranging from Barrett's Oesophagus to oesophageal cancer. Current surveillance protocol consists of periodic endoscopic examinations performed in 3-4 month intervals including expert's visual assessment and biopsies taken from suspicious tissue regions. Recent development of a new imaging technology, called probe-based confocal laser endomicroscopy (pCLE), enabled the acquisition of in vivo optical biopsies without removing any tissue sample. Besides its several advantages, i.e., noninvasiveness, real-time and in vivo feedback, optical biopsies involve a new challenge for the endoscopic expert. Due to their noninvasive nature, optical biopsies do not leave any scar on the tissue and therefore recognition of the previous optical biopsy sites in surveillance endoscopy becomes very challenging. In this work, we introduce a clustering and classification framework to facilitate retargeting previous optical biopsy sites in surveillance upper GI-endoscopies. A new representation of endoscopic videos based on manifold learning, "endoscopic video manifolds" (EVMs), is proposed. The low dimensional EVM representation is adapted to facilitate two different clustering tasks; i.e., clustering of informative frames and patient specific endoscopic segments, only by changing the similarity measure. Each step of the proposed framework is validated on three in vivo patient datasets containing 1834, 3445, and 1546 frames, corresponding to endoscopic videos of 73.36, 137.80, and 61.84 s, respectively. Improvements achieved by the introduced EVM representation are demonstrated by quantitative analysis in comparison to the original image representation and principal component analysis. Final experiments evaluating the complete framework demonstrate the feasibility of the proposed method as a promising step for assisting the endoscopic expert in retargeting the

  15. Control of respiration-driven retrograde flow in the subdiaphragmatic venous return of the Fontan circulation

    PubMed Central

    Vukicevic, M; Conover, T; Jaeggli, M; Zhou, J; Pennati, G; Hsia, TY; Figliola, RS

    2014-01-01

    Respiration influences the subdiaphragmatic venous return in the total cavopulmonary connection (TCPC) of the Fontan circulation whereby both the inferior vena cava (IVC) and hepatic vein flows can experience retrograde motion. Controlling retrograde flows could improve patient outcomes. Using a patient-specific model within a Fontan mock circulatory system with respiration, we inserted a valve into the IVC to examine its effects on local hemodynamics while varying retrograde volumes by changing vascular impedances. A bovine valved conduit reduced IVC retrograde flow to within 3% of antegrade flow in all cases. The valve closed only under conditions supporting retrograde flow and its effects on local hemodynamics increased with larger retrograde volume. Liver and TCPC pressures improved only while the valve leaflets were closed while cycle-averaged pressures improved only slightly (italic>1 mm Hg). Increased pulmonary vascular resistance raised mean circulation pressures but the valve functioned and cardiac output improved and stabilized. Power loss across the TCPC improved by 12–15% (pbold>0.05) with a valve. The effectiveness of valve therapy is dependent on patient vascular impedance. PMID:24814833

  16. Retrogradation of Waxy Rice Starch Gel in the Vicinity of the Glass Transition Temperature

    PubMed Central

    Charoenrein, Sanguansri; Udomrati, Sunsanee

    2013-01-01

    The retrogradation rate of waxy rice starch gel was investigated during storage at temperatures in the vicinity of the glass transition temperature of a maximally concentrated system (Tg′), as it was hypothesized that such temperatures might cause different effects on retrogradation. The Tg′ value of fully gelatinized waxy rice starch gel with 50% water content and the enthalpy of melting retrograded amylopectin in the gels were investigated using differential scanning calorimetry. Starch gels were frozen to −30°C and stored at 4, 0, −3, −5, and −8°C for 5 days. The results indicated that the Tg′ value of gelatinized starch gel annealed at −7°C for 15 min was −3.5°C. Waxy rice starch gels retrograded significantly when stored at 4°C with a decrease in the enthalpy of melting retrograded starch in samples stored for 5 days at −3, −5, and −8°C, respectively, perhaps due to the more rigid glass matrix and less molecular mobility facilitating starch chain recrystallization at temperatures below Tg′. This suggests that retardation of retrogradation of waxy rice starch gel can be achieved at temperature below Tg′. PMID:26904602

  17. Focal retrograde amnesia: voxel-based morphometry findings in a case without MRI lesions.

    PubMed

    Sehm, Bernhard; Frisch, Stefan; Thöne-Otto, Angelika; Horstmann, Annette; Villringer, Arno; Obrig, Hellmuth

    2011-01-01

    Focal retrograde amnesia (FRA) is a rare neurocognitive disorder presenting with an isolated loss of retrograde memory. In the absence of detectable brain lesions, a differentiation of FRA from psychogenic causes is difficult. Here we report a case study of persisting FRA after an epileptic seizure. A thorough neuropsychological assessment confirmed severe retrograde memory deficits while anterograde memory abilities were completely normal. Neurological and psychiatric examination were unremarkable and high-resolution MRI showed no neuroradiologically apparent lesion. However, voxel-based morphometry (VBM)-comparing the MRI to an education-, age-and sex-matched control group (n = 20) disclosed distinct gray matter decreases in left temporopolar cortex and a region between right posterior parahippocampal and lingual cortex. Although the results of VBM-based comparisons between a single case and a healthy control group are generally susceptible to differences unrelated to the specific symptoms of the case, we believe that our data suggest a causal role of the cortical areas detected since the retrograde memory deficit is the preeminent neuropsychological difference between patient and controls. This was paralleled by grey matter differences in central nodes of the retrograde memory network. We therefore suggest that these subtle alterations represent structural correlates of the focal retrograde amnesia in our patient. Beyond the implications for the diagnosis and etiology of FRA, our results advocate the use of VBM in conditions that do not show abnormalities in clinical radiological assessment, but show distinct neuropsychological deficits. PMID:22028902

  18. Retrograde reactions in coal processing: The behavior of ether and sulfide model compounds

    SciTech Connect

    Buchanan, A.C. III; Britt, P.F.; Skeen, J.T.

    1997-04-01

    Retrograde reactions that produce more refractory molecular structures are undesirable in coal liquefaction. The authors previously found that restricted mass transport, induced by immobilization on a silica support, promotes retrograde reactions for 1,2-diphenylethane (C{sub 6}H{sub 5}CH{sub 2}CH{sub 2}C{sub 6}H{sub 5}) by both skeletal rearrangement and ring growth (cyclization-dehydrogenation) pathways involving free-radical intermediates. They are now examining the influence of heteroatoms on the retrograde pathways for the corresponding surface-immobilized ether (C{sub 6}H{sub 5}OCH{sub 2}C{sub 6}H{sub 5}) and sulfide (C{sub 6}H{sub 5}SCH{sub 2}C{sub 6}H{sub 5}) model compounds at 275--350 C. Cyclization-dehydrogenation pathways are not detected for either model compound. However, retrograde skeletal rearrangements involving 1,2-phenyl shifts in C{sub 6}H{sub 5}XCH{center_dot}C{sub 6}H{sub 5} (X = O,S) are found to be significant under restricted diffusion, and for X = O, radical coupling at ring carbons to form benzylphenols is also observed as a major pathway. For surface-immobilized benzyl phenyl ether, the two retrograde processes account for ca. 50% of the thermolysis products, and also generate reactive hydroxyl and keto functionalities that can be involved in additional retrograde reactions.

  19. Post-Golgi anterograde transport requires GARP-dependent endosome-to-TGN retrograde transport

    PubMed Central

    Hirata, Tetsuya; Fujita, Morihisa; Nakamura, Shota; Gotoh, Kazuyoshi; Motooka, Daisuke; Murakami, Yoshiko; Maeda, Yusuke; Kinoshita, Taroh

    2015-01-01

    The importance of endosome-to–trans-Golgi network (TGN) retrograde transport in the anterograde transport of proteins is unclear. In this study, genome-wide screening of the factors necessary for efficient anterograde protein transport in human haploid cells identified subunits of the Golgi-associated retrograde protein (GARP) complex, a tethering factor involved in endosome-to-TGN transport. Knockout (KO) of each of the four GARP subunits, VPS51–VPS54, in HEK293 cells caused severely defective anterograde transport of both glycosylphosphatidylinositol (GPI)-anchored and transmembrane proteins from the TGN. Overexpression of VAMP4, v-SNARE, in VPS54-KO cells partially restored not only endosome-to-TGN retrograde transport, but also anterograde transport of both GPI-anchored and transmembrane proteins. Further screening for genes whose overexpression normalized the VPS54-KO phenotype identified TMEM87A, encoding an uncharacterized Golgi-resident membrane protein. Overexpression of TMEM87A or its close homologue TMEM87B in VPS54-KO cells partially restored endosome-to-TGN retrograde transport and anterograde transport. Therefore GARP- and VAMP4-dependent endosome-to-TGN retrograde transport is required for recycling of molecules critical for efficient post-Golgi anterograde transport of cell-surface integral membrane proteins. In addition, TMEM87A and TMEM87B are involved in endosome-to-TGN retrograde transport. PMID:26157166

  20. Control of respiration-driven retrograde flow in the subdiaphragmatic venous return of the Fontan circulation.

    PubMed

    Vukicevic, Marija; Conover, Timothy; Jaeggli, Michael; Zhou, Jian; Pennati, Giancarlo; Hsia, Tain-Yen; Figliola, Richard S

    2014-01-01

    Respiration influences the subdiaphragmatic venous return in the total cavopulmonary connection (TCPC) of the Fontan circulation whereby both the inferior vena cava (IVC) and hepatic vein flows can experience retrograde motion. Controlling retrograde flows could improve patient outcomes. Using a patient-specific model within a Fontan mock circulatory system with respiration, we inserted a valve into the IVC to examine its effects on local hemodynamics while varying retrograde volumes by changing vascular impedances. A bovine valved conduit reduced IVC retrograde flow to within 3% of antegrade flow in all cases. The valve closed only under conditions supporting retrograde flow and its effects on local hemodynamics increased with larger retrograde volume. Liver and TCPC pressures improved only when the valve leaflets were closed whereas cycle-averaged pressures improved only slightly (<1 mm Hg). Increased pulmonary vascular resistance raised mean circulation pressures, but the valve functioned and cardiac output improved and stabilized. Power loss across the TCPC improved by 12%-15% (p < 0.05) with a valve. The effectiveness of valve therapy is dependent on patient vascular impedance. PMID:24814833

  1. Anatomy of the ethmoid: CT, endoscopic, and macroscopic

    SciTech Connect

    Terrier, F.; Weber, W.; Ruefenacht, D.; Porcellini, B.

    1985-03-01

    The authors illustrate the normal CT anatomy of the ethmoid region and correlate it with the endoscopic and macroscopic anatomy to define landmarks that can be recognized on CT and during endoscopically controlled transnasal ethmoidectomy.

  2. Endoscopic ultrasound guided antitumor therapy.

    PubMed

    Bhutani, M S

    2003-08-01

    This paper will review the possibilities of EUS guided anti-tumor therapy. Ablative energy may be delivered to a tumor under EUS guidance to destruct tumor cells by ultrasound itself, radiofrequency or radiation. Pilot results of endoscopic high intensity focused ultrasound in a human trial have been reported. The feasibility of performing EUS guided radiofrequency ablation has been reported in a swine model. An EUS bases radiation target simulation method has been developed for anal cancer therapy. Targeted delivery of an anti-cancer agent into a tumor under EUS guidance is possible as reported in an early clinical trial of local immunotherapy (Cytoimplant) or modified viruses delivered by EUS guided fine needle injection in patients with advanced pancreatic carcinoma. Image guided injection of alcohol is another approach used for local tumor ablation. Application of other ablation therapies such as laser, microwave and cryo is also conceptually feasible. We will have to wait and see where these initial and ongoing attempts for applying EUS against cancer take us. PMID:12929056

  3. Contrast-Enhanced Endoscopic Ultrasound

    PubMed Central

    Dietrich, Christoph F.; Sharma, M.; Hocke, M.

    2012-01-01

    The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) introduced guidelines on the use of contrast-enhanced ultrasound (CEUS) in 2004. This EFSUMB-document focused mainly on liver applications. However, new applications extending beyond the liver were developed thereafter. Increased interest in recent years in CEUS technique and in the application of CEUS in novel fields like endoscopic ultrasound (EUS) has revolutionized indications and applications. As a result, the EFSUMB initiated a new update of the guidelines in 2011 to include this additional knowledge. Some of the contrast-enhanced EUS (CE-EUS) indications are established, whereas others are preliminary; these latter indications are categorized as emergent CEUS applications since the available evidence is insufficient for general recommendation. This article focuses on the use of CE-EUS in various clinical settings. The reader will get an overview of current indications and possible applications of CE-EUS. This involves the introduction of different contrast studies including color Doppler techniques (known as contrast-enhanced high mechanical index endosonography or CEHMI-EUS) as well as more modern high-resolution contrast-enhanced techniques (known as contrast-enhanced low mechanical index endosonography or CELMI EUS). PMID:24949350

  4. Endoscopic metrology for cardiovascular flows studies

    NASA Astrophysics Data System (ADS)

    Arévalo, Laura; Roche, Eva; Palero, Virginia; Andrés, Nieves; Lobera, Julia; Martínez, Miguel Ángel; Arroyo, M. Pilar

    2014-07-01

    The complete measurement of the blood velocity and the vein wall deformation is important in order to obtain the wall shear stress distribution in blood vessels. This information would facilitate the diagnosis and treatment of some cardiovascular diseases. In this work, endoscopy has been combined with high speed Particle Image Velocimetry (PIV) to obtain the flow velocity inside a transparent vessel model and with digital holography to measure the vessel wall deformation. The use of endoscopes presents different advantages: they allow the simultaneous illumination and imaging of the object under inspection; the endoscopes can be moved as close as required and can be located anywhere to observe different regions. They can be used for observing inside opaque vessels in an oblique way, where the image perspective distortion can be corrected numerically. High speed PIV and endoscopic PIV have been applied to evaluate the influence of an antithrombotic filter in the velocity field inside an inferior vena cava (IVC) model. Endoscopic digital holography has been developed to measure the wall deformation in vessel models with steady and pulsatile flows. The models present different flexibility and opacity grades. Both the vessel model and the endoscope end are immersed in a refractive index matching liquid in order to avoid distortions.

  5. Single-channel prototype terahertz endoscopic system

    NASA Astrophysics Data System (ADS)

    Doradla, Pallavi; Alavi, Karim; Joseph, Cecil; Giles, Robert

    2014-08-01

    We demonstrate the design and development of an innovative single-channel terahertz (THz) prototype endoscopic imaging system based on flexible metal-coated THz waveguides and a polarization specific detection technique. The continuous-wave (CW) THz imaging system utilizes a single channel to transmit and collect the reflected intrinsic THz signal from the sample. Since the prototype system relies on a flexible waveguide assembly that is small enough in diameter, it can be readily integrated with a conventional optical endoscope. This study aims to show the feasibility of waveguide enabled THz imaging. We image various objects in transmission and reflection modes. We also image normal and cancerous colonic tissues in reflectance mode using a polarization specific imaging technique. The resulting cross-polarized THz reflectance images showed contrast between normal and cancerous colonic tissues at 584 GHz. The level of contrast observed using endoscopic imaging correlates well with contrast levels observed in ex vivo THz reflectance studies of colon cancer. This indicates that the single-channel flexible waveguide-based THz endoscope presented here represents a significant step forward in clinical endoscopic application of THz technology to aid in in vivo cancer screening.

  6. Endonasal Endoscopic Closure of Cerebrospinal Fluid Rhinorrhea

    PubMed Central

    Schmerber, S.; Righini, Ch.; Lavielle, J.-P.; Passagia, J.-G.; Reyt, E.

    2001-01-01

    The authors review their experience with endoscopic repair of skull base defects associated with cerebrospinal fluid (CSF) rhinorrhea involving the paranasal sinuses. A total of 22 patients was treated endoscopically between 1992 and 1998. The repair method consisted of closure of the CSF fistula with a free autologous abdominal fat graft and fibrin glue, supported with a sheet of silastic. The primary closure rate was 82% (18/22), and the overall closure rate was 95.5% (21/22) without recurrence or complications within an average follow-up of 5 years (14-83 months). A single patient still complains of cerebrospinal rhinorrhea, although this was never proved by any clinical, endoscopic, or biological (β2-transferrin) examination. The repair of ethmoidal-sphenoidal cerebrospinal fluid fistulae by endonasal endoscopic surgery is an excellent technique, both safe and effective. Fat is a material of choice, as it is tight and resists infection well. The technique and indications for endoscopic management of cerebrospinal fluid leaks are discussed. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:17167603

  7. Future directions of duodenal endoscopic submucosal dissection

    PubMed Central

    Matsumoto, Satohiro; Miyatani, Hiroyuki; Yoshida, Yukio

    2015-01-01

    Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure. PMID:25901218

  8. Ultrahigh-resolution endoscopic optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Chen, Yu; Herz, Paul R.; Hsiung, Pei-Lin; Aguirre, Aaron D.; Mashimo, Hiroshi; Desai, Saleem; Pedrosa, Macos; Koski, Amanda; Schmitt, Joseph M.; Fujimoto, James G.

    2005-01-01

    Early detection of gastrointestinal cancer is essential for the patient treatment and medical care. Endoscopically guided biopsy is currently the gold standard for the diagnosis of early esophageal cancer, but can suffer from high false negative rates due to sampling errors. Optical coherence tomography (OCT) is an emerging medical imaging technology which can generate high resolution, cross-sectional images of tissue in situ and in real time, without the removal of tissue specimen. Although endoscopic OCT has been used successfully to identify certain pathologies in the gastrointestinal tract, the resolution of current endoscopic OCT systems has been limited to 10 - 15 m for clinical procedures. In this study, in vivo imaging of the gastrointestinal tract is demonstrated at a three-fold higher resolution (< 5 m), using a portable, broadband, Cr4+:Forsterite laser as the optical light source. Images acquired from the esophagus, gastro-esophageal junction and colon on animal model display tissue microstructures and architectural details at high resolution, and the features observed in the OCT images are well-matched with histology. The clinical feasibility study is conducted through delivering OCT imaging catheter using standard endoscope. OCT images of normal esophagus, Barrett's esophagus, and esophageal cancers are demonstrated with distinct features. The ability of high resolution endoscopic OCT to image tissue morphology at an unprecedented resolution in vivo would facilitate the development of OCT as a potential imaging modality for early detection of neoplastic changes.

  9. Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

    PubMed Central

    Mori, Hirohito; Kobayashi, Nobuya; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Chiyo, Taiga; Ayaki, Maki; Nagase, Takashi; Masaki, Tsutomu

    2016-01-01

    AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not. METHODS: Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port. CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human. PMID:27053847

  10. 21 CFR 876.1500 - Endoscope and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Endoscope and accessories. 876.1500 Section 876.1500 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Diagnostic Devices § 876.1500 Endoscope and accessories. (a) Identification. An endoscope...

  11. Properties of Cores Formed by Retrograde Minor Mergers.

    NASA Astrophysics Data System (ADS)

    Bak, J.

    1999-09-01

    In the last 10 years over a dozen elliptical galaxies have been observed to posses a core which rotates counter to the rest of the galaxy. In one formation scenario, dynamical friction causes a compact companion to spiral into the center of a much larger elliptical galaxy on a retrograde orbit relative to the larger galaxy's rotation. If the core of the smaller galaxy is not tidally disrupted it may carry some of it's orbital angular momentum to the center. I present results from N-body simulations, which cover the parameter space over which satellite accretion is most likely to form counter rotating cores. The kinematic parts of the results are analyzed using the penalized likelihood method of Merritt to calculate 2D line-of-sight velocity fields, including third and fourth order Gauss-Hermite terms. By combining this method with IRAF, the photometric aspects of the results are analyzed and compared with observations. The results indicate that dissipationless satellite accretion can only form counter rotating cores when the larger galaxy's intrinsic angular momentum is almost perfectly antiparallel to the orbital angular momentum of the satellite. In most other cases a kinematically distinct core is formed. I present statistical properties of the cores, which include the deviations from pure isophote ellipses as well as deviations of the line-of-sight velocity profiles from a pure Gaussian form. To test the robustness of the results, some of the simulations are redone with a minor amount of dissipation added to the satellite. These simulations indicate that including small amounts of gas does not significantly effect the conclusions. I would like to thank the Student Stipend Committee for making this presentation possible.

  12. Comparison of endoscopic papillary balloon dilatation and endoscopic sphincterotomy for bile duct stones

    PubMed Central

    Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Jun-ichi; Kusakabe, Yuko; Yasui, Shin; Mikata, Rintaro; Yokosuka, Osamu

    2016-01-01

    Endoscopic treatment for bile duct stones is low-invasive and currently considered as the first choice of the treatment. For the treatment of bile duct stones, papillary treatment is necessary, and the treatments used at the time are broadly classified into two types; endoscopic papillary balloon dilatation where bile duct closing part is dilated with a balloon and endoscopic sphincterotomy (EST) where bile duct closing part is incised. Both procedures have advantages and disadvantages. Golden standard is EST, however, there are patients with difficulty for EST, thus we must select the procedure based on understanding of the characteristics of the procedure, and patient backgrounds. PMID:27247706

  13. Catheter-based photoacoustic endoscope for use in the instrument channel of a clinical video endoscope

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

    We have successfully developed a fully-sheathed, flexible shaft-based, mechanical scanning photoacoustic endoscopy (PAE) system for imaging the human gastrointestinal tract via the instrument channel of a clinical video endoscope. The endoscopic system uses a single element ultrasonic transducer and flexible shaft-based proximal actuation mechanism, and it has a 2.5 m long and 3.2 mm diameter catheter section, which can be accommodated in the 3.7 mm diameter instrument channel of a clinical video endoscope. Here, we demonstrate the intra-instrument channel workability and in vivo imaging capability of the PAE system.

  14. Comparison of endoscopic papillary balloon dilatation and endoscopic sphincterotomy for bile duct stones.

    PubMed

    Sakai, Yuji; Tsuyuguchi, Toshio; Sugiyama, Harutoshi; Hayashi, Masahiro; Senoo, Jun-Ichi; Kusakabe, Yuko; Yasui, Shin; Mikata, Rintaro; Yokosuka, Osamu

    2016-05-25

    Endoscopic treatment for bile duct stones is low-invasive and currently considered as the first choice of the treatment. For the treatment of bile duct stones, papillary treatment is necessary, and the treatments used at the time are broadly classified into two types; endoscopic papillary balloon dilatation where bile duct closing part is dilated with a balloon and endoscopic sphincterotomy (EST) where bile duct closing part is incised. Both procedures have advantages and disadvantages. Golden standard is EST, however, there are patients with difficulty for EST, thus we must select the procedure based on understanding of the characteristics of the procedure, and patient backgrounds. PMID:27247706

  15. Endoscopic Ultrasound in Gastroenteropancreatic Neuroendocrine Tumors

    PubMed Central

    2012-01-01

    Endoscopic ultrasound (EUS) is an advanced endoscopic technique currently used in the staging and diagnosis of many gastrointestinal neoplasms. The proximity of the echoendoscope to the gastrointestinal tract lends itself to a detailed view of the luminal pathology and the pancreas. This unique ability enables endoscopists to use EUS in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Diagnostic EUS allows previously unidentified NETs to be localized. EUS also determines tumor management by staging the GEP-NETS, enabling the clinicians to choose the appropriate endoscopic or surgical management. The ability to obtain a tissue diagnosis with EUS guidance enables disease confirmation. Finally, recent developments suggest that EUS may be used to deliver therapeutic agents for the treatment of NETs. This review will highlight the advances in our knowledge of EUS in the clinical management of these tumors. PMID:23170141

  16. Endoscopic management of orbital apex lesions.

    PubMed

    Sethi, D S; Lau, D P

    1997-01-01

    Lesions of the orbital apex often present a diagnostic dilemma. Clinical assessment and imaging studies are helpful but a tissue biopsy is often required. The morbidity associated with transcranial approaches to the orbital apex may outweigh the benefits of obtaining a biopsy by these routes. Fine needle aspiration cytology of orbital apex lesions can be performed but there are disadvantages with this method. We describe a transnasal endoscopic technique to biopsy the orbital apex. The technique was used successfully to obtain a tissue diagnosis in six patients with orbital apex lesions. This enabled commencement of definitive treatment. There were no significant complications. The transnasal approach to the orbital apex using the endoscopes is reliable. Endoscopes provide excellent illumination, magnification, and a panoramic view of the operative field. PMID:9438058

  17. [Per-oral endoscopic myotomy in achalasia].

    PubMed

    Ponds, Fraukje A M; Smout, André J P M; Bredenoord, Albert J; Fockens, Paul

    2015-01-01

    The treatment of patients with achalasia is complex due to a considerably high recurrence rate and risk of treatment-related complications. The per-oral endoscopic myotomy (POEM) is a new endoscopic technique that combines the benefits of a minimally invasive endoscopic procedure with the efficacy of a surgical myotomy. Implementation of the POEM technique may lead to fewer complications, a lower recurrence rate and reduced costs. During the procedure, a myotomy of the circular muscle layer of the oesophagus is performed after creating a submucosal tunnel in the oesophagus. The first studies of this new technique show promising results. Experienced therapeutic endoscopists can learn to perform the POEM technique relatively easily. Further studies are needed to compare this technique with the current standard treatments and to evaluate long-term effects. PMID:25990334

  18. Development of 3D holographic endoscope

    NASA Astrophysics Data System (ADS)

    Özcan, Meriç; Önal Tayyar, Duygu

    2016-03-01

    Here we present the development of a 3D holographic endoscope with an interferometer built around a commercial rigid endoscope. We consider recording the holograms with coherent and incoherent light separately without compromising the white light imaging capacity of the endoscope. In coherent light based recording, reference wave required for the hologram is obtained in two different ways. First, as in the classical holography, splitting the laser beam before the object illumination, and secondly creating the reference beam from the object beam itself. This second method does not require path-length matching between the object wave and the reference wave, and it allows the usage of short coherence length light sources. For incoherent light based holographic recordings various interferometric configurations are considered. Experimental results on both illumination conditions are presented.

  19. [Applications of clips in current endoscopic therapeutics].

    PubMed

    Rivero Fernández, Miguel; González Martín, Juan Angel; Vázquez-Sequeiros, Enrique

    2010-03-01

    The applications of clips in current therapeutics are increasingly numerous. Endoscopic hemoclipping for acute nonvariceal bleeding is a highly effective and safe modality for hemostasis with initial hemostatic rates of between 85 and 98% and a rebleeding rate of approximately 5-10% both in patients with peptic ulcer bleeding and signs of endoscopic risk (Forrest Ia-IIb) and in bleeding secondary to submucosal lesions, diverticular bleeding, Mallory-Weiss tear, bleeding Dieulafoy's lesions, and postpolypectomy bleeding. In addition to the effectiveness of this technique as a hemostatic mechanism, many publications have demonstrated the utility of these clips to close perforations and fistulas, to serve as a radiopaque marker and as a tool to fix accessories (feeding tubes or prostheses). However, endoscopic clipping has certain limitations depending on the nature of the injury and the type of patient, as well as high economic cost and some technical limitations. PMID:19713002

  20. Compact stereo endoscopic camera using microprism arrays.

    PubMed

    Yang, Sung-Pyo; Kim, Jae-Jun; Jang, Kyung-Won; Song, Weon-Kook; Jeong, Ki-Hun

    2016-03-15

    This work reports a microprism array (MPA) based compact stereo endoscopic camera with a single image sensor. The MPAs were monolithically fabricated by using two-step photolithography and geometry-guided resist reflow to form an appropriate prism angle for stereo image pair formation. The fabricated MPAs were transferred onto a glass substrate with a UV curable resin replica by using polydimethylsiloxane (PDMS) replica molding and then successfully integrated in front of a single camera module. The stereo endoscopic camera with MPA splits an image into two stereo images and successfully demonstrates the binocular disparities between the stereo image pairs for objects with different distances. This stereo endoscopic camera can serve as a compact and 3D imaging platform for medical, industrial, or military uses. PMID:26977690

  1. Endothelin-1 impairs retrograde axonal transport and leads to axonal injury in rat optic nerve.

    PubMed

    Taniguchi, Takazumi; Shimazawa, Masamitsu; Sasaoka, Masaaki; Shimazaki, Atsushi; Hara, Hideaki

    2006-05-01

    The purpose of this study was to examine the effects of endothelin-1 (ET-1) on retrograde axonal transport in the rat optic nerve. Vehicle or ET-1 (0.2, 1, or 5 pmol/eye) were injected into the vitreous body in Sprague-Dawley rats. Retinal vessels were observed, using a fundus camera, before, and at 10 min, 3 days and 7 days after a single intravitreous injection. Two days after the injection, a neuronal tracer, fluoro gold, was administered via the superior colliculi to retrogradely label active retinal ganglion cells (RGCs). Five days after the tracer administration, retrogradely labeled RGCs were evaluated in the flat-mounted retina, and cross sections from each optic nerve were graded for injury by four independent, masked observers. ET-1 at 5 pmol/eye caused a significant constriction of retinal vessels (versus the vehicle-treated group) at 10 min after the injection. Intravitreous injection of ET-1 caused a dose-related decrease in the number of retrogradely labeled RGCs. Injection of 5 pmol/eye ET-1 led to a statistically significant decrease in the number of retrogradely labeled RGCs (versus the vehicle-treated group). ET-1 at 1 and 5 pmol/eye caused histological optic nerve damage (evaluated using a graded scale). The histological optic nerve damage correlated with the number of retrogradely labeled RGCs. In conclusion, a single intravitreous injection of ET-1 impaired retrograde axonal transport in the rat optic nerve and this impairment correlated with the histological optic nerve damage. PMID:16719791

  2. On remembering and forgetting our autobiographical pasts: retrograde amnesia and Andrew Mayes's contribution to neuropsychological method.

    PubMed

    Kopelman, M D; Bright, P

    2012-11-01

    Andrew Mayes's contribution to the neuropsychology of memory has consisted in steadily teasing out the nature of the memory deficit in the amnesic syndrome. This has been done with careful attention to matters of method at all stages. This particularly applies to his investigations of forgetting rates in amnesia and to his studies of retrograde amnesia. Following a brief outline of his work, the main current theories of retrograde amnesia are considered: consolidation theory, episodic-to-semantic shift theory, and multiple trace theory. Findings across the main studies in Alzheimer dementia are reviewed to illustrate what appears to be consistently found, and what is much more inconsistent. A number of problems and issues in current theories are then highlighted--including the nature of the temporal gradient, correlations with the extent of temporal lobe damage, what we would expect 'normal' remote memory curves to look like, how they would appear in focal retrograde amnesia, and whether we can pinpoint retrograde amnesia to hippocampal/medial temporal damage on the basis of existing studies. A recent study of retrograde amnesia is re-analysed to demonstrate temporal gradients on recollected episodic memories in hippocampal/medial temporal patients. It is concluded that there are two requirements for better understanding of the nature of retrograde amnesia: (i) a tighter, Mayesian attention to method in terms of both the neuropsychology and neuroimaging in investigations of retrograde amnesia; and (ii) acknowledging that there may be multiple factors underlying a temporal gradient, and that episodic and semantic memory show important interdependencies at both encoding and retrieval. Such factors may be critical to understanding what is remembered and what is forgotten from our autobiographical pasts. PMID:22884958

  3. The Fully Endoscopic Acoustic Neuroma Surgery.

    PubMed

    Marchioni, Daniele; Carner, Marco; Rubini, Alessia; Nogueira, João Flávio; Masotto, Barbara; Alicandri-Ciufelli, Matteo; Presutti, Livio

    2016-10-01

    Surgical approaches to vestibular schwannomas (VS) are widely known and extensively recorded. For the first time, an exclusive endoscopic approach to the internal acoustic canal (IAC) was described and used to safely remove a cochlear schwannoma involving IAC in March 2012. The aim of this article was to summarize indications and technique to treat intracanalicular VS by transcanal/transpromontorial endoscopic approach. Because management of intracanalicular VSs is complex and strongly debated, this kind of therapeutic option in the appropriate and selected cases could modify classic concepts of the management of this pathology. PMID:27565388

  4. Endoscopic retrieval of baggies in body stuffers

    PubMed Central

    Shabani, Mahtab; Zamani, Nasim; Hassanian-Moghaddam, Hossein

    2016-01-01

    Background and study aims: Body packing/stuffing is currently a huge medical problem. A conservative approach and waiting for spontaneous packet expulsion are usually recommended. However, in a patient with packets stuck in the stomach, surgical treatments are generally advocated if complications occur. Endoscopic evacuation of the packets is generally not favored because of its potential hazards, including manipulation and rupture of the packets and deterioration of the patients' condition. However, it may prevent more invasive treatment modalities including surgical intervention. We present case reports on four symptomatic body stuffers with potentially dangerous ingestions who underwent endoscopic evacuation of their packets and survived. PMID:27092325

  5. [Achalasia: role of endoscopic therapy and surgery].

    PubMed

    Abbes, Leila; Leconte, Mahaut; Coriat, Romain; Dousset, Bertrand; Chaussade, Stanislas; Gaudric, Marianne

    2013-05-01

    Pneumatic dilation of achalasia has a same medium-term efficacy than surgery and is commonly proposed as the first-line treatment. Intra-sphincteric injection of botulinum toxin is reserved for elderly patients with serious comorbidities. Per-endoscopic myotomy is possible but needs to be evaluated by further studies. Laparoscopic Heller's myotomy in first intension is reserved for young patients less than 40 years. Results of Heller's myotomy are not modified by prior endoscopic treatment or by mega-esophagus. Better surgery results are shown in recent and severe achalasia. PMID:22959337

  6. Endoscopic Pubic Symphysectomy for Recalcitrant Osteitis Pubis

    PubMed Central

    Gupta, Asheesh; Redmond, John M.; Hammarstedt, Jon E.; Suarez-Ahedo, Carlos; Martin, Timothy J.; Matsuda, Dean K.; Domb, Benjamin G.

    2015-01-01

    Recalcitrant osteitis pubis presents a challenging problem for orthopaedic surgeons. Various surgical interventions have been described for treatment, including opening-wedge resection, symphysiodesis, and curettage. We propose that endoscopic pubic symphysectomy offers an effective method of treating such a challenging problem. This article describes in detail the technique used to perform endoscopic pubic symphysectomy, and a companion video demonstrating the procedure is included. Our experience suggests that removal of the interpubic fibrocartilaginous lamina and resection of approximately 1 cm of bone can successfully eliminate all sources of pain and dysfunction caused by the recalcitrant osteitis pubis. PMID:26052486

  7. Endoscopic Pubic Symphysectomy for Recalcitrant Osteitis Pubis.

    PubMed

    Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Suarez-Ahedo, Carlos; Martin, Timothy J; Matsuda, Dean K; Domb, Benjamin G

    2015-04-01

    Recalcitrant osteitis pubis presents a challenging problem for orthopaedic surgeons. Various surgical interventions have been described for treatment, including opening-wedge resection, symphysiodesis, and curettage. We propose that endoscopic pubic symphysectomy offers an effective method of treating such a challenging problem. This article describes in detail the technique used to perform endoscopic pubic symphysectomy, and a companion video demonstrating the procedure is included. Our experience suggests that removal of the interpubic fibrocartilaginous lamina and resection of approximately 1 cm of bone can successfully eliminate all sources of pain and dysfunction caused by the recalcitrant osteitis pubis. PMID:26052486

  8. Laser-assisted percutaneous endoscopic neurolysis.

    PubMed

    Epstein, J M; Adler, R

    2000-01-01

    Endoscopic lysis of adhesive scar utilizing a steerable fiberoptic scope is currently being performed by a growing number of physicians. Various techniques and medications are presently being used to lyse epidural adhesions as a way of improving refractory lumbar radiculopathies. We present a case report discussing laser-assisted endoscopic lysis with radiographic images before and after laser-assisted neurolysis. We were able to demonstrate improvement in the filling of the nerve root with epidural contrast after the laser lysis of scar. This correlated with improvement in pain without neurologic deficit. The laser may represent a useful adjunct in the treatment of pain due to epidural fibrosis. PMID:16906206

  9. A brief history of endoscopic spine surgery.

    PubMed

    Telfeian, Albert E; Veeravagu, Anand; Oyelese, Adetokunbo A; Gokaslan, Ziya L

    2016-02-01

    Few neurosurgeons practicing today have had training in the field of endoscopic spine surgery during residency or fellowship. Nevertheless, over the past 40 years individual spine surgeons from around the world have worked to create a subfield of minimally invasive spine surgery that takes the point of visualization away from the surgeon's eye or the lens of a microscope and puts it directly at the point of spine pathology. What follows is an attempt to describe the story of how endoscopic spine surgery developed and to credit some of those who have been the biggest contributors to its development. PMID:26828883

  10. Endoscopic palliation of malignant biliary strictures

    PubMed Central

    Salgado, Sanjay M; Gaidhane, Monica; Kahaleh, Michel

    2016-01-01

    Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies. PMID:26989459

  11. Endoscopic management of inflammatory bowel disease strictures

    PubMed Central

    Vrabie, Raluca; Irwin, Gerald L; Friedel, David

    2012-01-01

    Stricture formation is a common complication of Crohn’s disease, occurring in approximately one third of all patients with this condition. While the traditional management of such strictures has been largely surgical, there have been case series going back three decades highlighting the potential role of endoscopic balloon dilation in this clinical setting. This review article summarizes the stricture pathogenesis, focusing on known clinical and genetic risk factors. It then highlights the endoscopic balloon dilation research to date, with particular emphasis on three large recent case series. It concludes by describing the literature consensus regarding specific methodology and presenting avenues for future investigations. PMID:23189221

  12. Hepatic applications of endoscopic ultrasound: Current status and future directions

    PubMed Central

    Srinivasan, Indu; Tang, Shou-Jiang; Vilmann, Andreas S; Menachery, John; Vilmann, Peter

    2015-01-01

    The diagnosis and staging of various gastrointestinal malignancies have been made possible with the use of endoscopic ultrasound, which is a relatively safe procedure. The field of endoscopic ultrasound is fast expanding due to advancements in therapeutic endoscopic ultrasound. Though various studies have established its role in gastrointestinal malignancies and pancreatic conditions, its potential in the field of hepatic lesions still remains vastly untapped. In this paper the authors attempt to review important and landmark trials, case series and case studies involving hepatic applications of endoscopic ultrasound, thus not only providing an overview of utilization of endoscopic ultrasound in various liver conditions but also speculating its future role. PMID:26640331

  13. Pancreatic pseudocysts--when and how to treat?

    PubMed

    Aghdassi, Alexander A; Mayerle, Julia; Kraft, Matthias; Sielenkämper, Andreas W; Heidecke, Claus-Dieter; Lerch, Markus M

    2006-01-01

    Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a possible pseudocyst-duct communication. Diagnosis is accomplished most often by CT scanning, by endoscopic retrograde cholangiopancreaticography (ERCP) or by ultrasound, and rapid progress in the improvement of diagnostic tools has enabled detection with high sensitivity and specificity. There are different therapeutic strategies: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The feasibility of endoscopic drainage is highly dependent on the anatomy and topography of the pseudocyst, but provides high success and low complication rates. Percutaneous drainage is used for infected pseudocysts. However, its usefulness in chronic pancreatitis-associated pseudocysts is questionable. Internal drainage and pseudocyst resection are frequently used as surgical approaches with a good overall outcome, but a somewhat higher morbidity and mortality compared with endoscopic intervention. We therefore conclude that pseudocyst treatment in chronic pancreatitis can be effectively achieved by both endoscopic and surgical means. PMID:18333098

  14. Pancreatic pseudocysts – when and how to treat?

    PubMed Central

    Aghdassi, Alexander A.; Mayerle, Julia; Kraft, Matthias; Sielenkämper, Andreas W.; Heidecke, Claus-Dieter

    2006-01-01

    Pancreatic pseudocysts are a well-known complication of acute or chronic pancreatitis, with a higher incidence in the latter. Currently several classification systems are in use that are based on the origin of the pseudocyst, their relation to pancreatic duct anatomy and a possible pseudocyst–duct communication. Diagnosis is accomplished most often by CT scanning, by endoscopic retrograde cholangiopancreaticography (ERCP) or by ultrasound, and rapid progress in the improvement of diagnostic tools has enabled detection with high sensitivity and specificity. There are different therapeutic strategies: endoscopic transpapillary or transmural drainage, percutaneous catheter drainage, or open surgery. The feasibility of endoscopic drainage is highly dependent on the anatomy and topography of the pseudocyst, but provides high success and low complication rates. Percutaneous drainage is used for infected pseudocysts. However, its usefulness in chronic pancreatitis-associated pseudocysts is questionable. Internal drainage and pseudocyst resection are frequently used as surgical approaches with a good overall outcome, but a somewhat higher morbidity and mortality compared with endoscopic intervention. We therefore conclude that pseudocyst treatment in chronic pancreatitis can be effectively achieved by both endoscopic and surgical means. PMID:18333098

  15. Endoscopic Resection for Small Rectal Neuroendocrine Tumors: Comparison of Endoscopic Submucosal Resection with Band Ligation and Endoscopic Submucosal Dissection

    PubMed Central

    Park, Jin Seok; Shin, Yong Woon; Kwon, Kye Sook

    2016-01-01

    Background and Aims. There is no consensus so far regarding the optimal endoscopic method for treatment of small rectal neuroendocrine tumor (NET). The aim of this study was to compare treatment efficacy, safety, and procedure time between endoscopic submucosal resection with band ligation (ESMR-L) and endoscopic submucosal dissection (ESD). Methods. We conducted a prospective study of patients who visited Inha University Hospital for endoscopic resection of rectal NET (≦10 mm). Pathological complete resection rate, procedure time, and complications were evaluated. Results. A total of 77 patients were treated by ESMR-L (n = 53) or ESD (n = 24). En bloc resection was achieved in all patients. A significantly higher pathological complete resection rate was observed in the ESMR-L group (53/53, 100%) than in the ESD group (13/24, 54.2%) (P = 0.000). The procedure time of ESD (17.9 ± 9.1 min) was significantly longer compared to that of ESMR-L (5.3 ± 2.8 min) (P = 0.000). Conclusions. Considering the clinical efficacy, technical difficulty, and procedure time, the ESMR-L method should be considered as the first-line therapy for the small rectal NET (≤10 mm). ESD should be left as a second-line treatment for the fibrotic lesion which could not be removed using the ESMR-L method. PMID:27525004

  16. Per-oral endoscopic myotomy: major advance in achalasia treatment and in endoscopic surgery.

    PubMed

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

    2014-12-21

    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

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

    PubMed Central

    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

  18. A New Irrigation System (Endosplash) for a Rigid Endoscope in Trans-sphenoidal Endoscopic Surgery

    PubMed Central

    KURODA, Rintarou; NAKAJIMA, Takeshi; YAMAGUCHI, Takashi; WATANABE, Eiju

    2016-01-01

    Obstruction of the visual field by blood is a major hindrance during endonasal endoscopic surgery, and a rapid and effective method for cleaning the lens is needed. We developed a new lens-cleaning system that does not employ a sheath or an irrigation-suction system. It is a 20-mm long cylinder with side holes that is attached to the barrel of the endoscope and is connected to a syringe containing saline. When the syringe is pressed, saline flows down to the tip along the barrel and washes the lens without requiring a sheath. We report the use of the system in six cases of endonasal endoscopic surgery. The lens was wiped significantly less often than during similar surgery performed without the use of this system. The Endosplash is simple and enables the surgeon to clean the lens with a single press of a syringe, thereby greatly enhancing the efficacy of endoscopic surgery. PMID:27063147

  19. Systematic Review of Endoscopic Middle Ear Surgery Outcomes

    PubMed Central

    Kozin, Elliott D.; Gulati, Shawn; Lehmann, Ashton; Remenschneider, Aaron K.; Kaplan, Alyson; Landegger, Lukas D.; Cohen, Michael S.; Lee, Daniel J.

    2015-01-01

    Objective Middle ear surgery increasingly employs endoscopes as an adjunct to or replacement for the operative microscope. Superior visualization and transcanal access to disease normally managed with a transmastoid approach are touted as advantages with the endoscope. No study, however, has systemically reviewed the literature to evaluate outcomes of endoscopic ear surgery (EES). We provide a systematic review of endoscope applications in middle ear surgery with an emphasis on outcomes. Data Sources PubMed, Embase, and Cochrane Methods A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. Articles were categorized based on study design, indication, and use of an endoscope either as an adjunct to or as a replacement for a microscope. Quantitative and descriptive analyses were performed. Results Ninety-one articles published between 1967 and 2014 met inclusion and exclusion criteria. The main indication for the use of an endoscope was cholesteatoma or myringoplasty. Of the identified articles, 40 provided a discrete discussion of outcomes. In cholesteatoma surgery, the endoscope has been mainly employed as an adjunct to the microscope, and although outcomes assessments vary across studies, the endoscope identified residual cholesteatoma in up to 50% of cases. Conclusion Endoscopes have been predominately used as an observational adjunct to the microscope to improve visualization of the tympanic cavity. Recent reports utilize the endoscope exclusively during surgical dissection; however, data comparing patient outcomes following the use of an operative endoscope versus a microscope are lacking. Areas in need of additional research are highlighted. PMID:25418475

  20. Retrograde binaries of massive black holes in circumbinary accretion discs

    NASA Astrophysics Data System (ADS)

    Amaro-Seoane, Pau; Maureira-Fredes, Cristián; Dotti, Massimo; Colpi, Monica

    2016-06-01

    accretion only explores the late evolution stages of the binary in an otherwise unperturbed retrograde disc to illustrate how eccentricity evolves with time in relation to the shape of the underlying surface density distribution.