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Sample records for delayed endoscopic sphincterotomy-induced

  1. Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination: A case report.

    PubMed

    Zhang, Zhen-Hai; Wu, Ya-Guang; Qin, Cheng-Kun; Su, Zhong-Xue; Xu, Jian; Xian, Guo-Zhe; Wu, Shuo-Dong

    2012-10-21

    Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endoscopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultrasonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi.

  2. 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

  3. Delayed perforation after endoscopic submucosal dissection for early gastric cancer: Clinical features and treatment

    PubMed Central

    Yano, Takafumi; Tanabe, Satoshi; Ishido, Kenji; Azuma, Mizutomo; Wada, Takuya; Suzuki, Mizuto; Kawanishi, Natsuko; Yamane, Sakiko; Sasaki, Tohru; Katada, Chikatoshi; Mikami, Tetsuo; Katada, Natsuya; Koizumi, Wasaburo

    2016-01-01

    Perforation is an important procedural complication of endoscopic submucosal dissection (ESD) for early gastric cancer. Although the incidence of delayed perforation after ESD is low, extreme caution is necessary because many cases require surgical intervention. Among 1984 lesions of early gastric cancer treated in our hospital by ESD in 1588 patients from September 2002 through March 2015, delayed perforation developed in 4 patients (4 lesions, 0.25%). A diagnosis of delayed perforation requires prompt action, including surgical intervention when required. PMID:27114751

  4. Delayed refractory hyperventilation following endoscopic third ventriculostomy in a 5-year-old boy.

    PubMed

    Merola, J; Liang, E; Hoskins, J; Balakrishnan, V; Gan, P

    2016-09-01

    We present the case of a 5-year-old boy who developed a delayed onset intractable hyperventilation following endoscopic third ventriculostomy. The proposed aetiology of this exceptionally rare phenomenon is discussed. To our knowledge, previous cases have only been reported in the adult population.

  5. Delayed perforation occurring after endoscopic submucosal dissection for early gastric cancer.

    PubMed

    Ikezawa, Kenji; Michida, Tomoki; Iwahashi, Kiyoshi; Maeda, Kosaku; Naito, Masafumi; Ito, Toshifumi; Katayama, Kazuhiro

    2012-01-01

    Delayed perforation occurring after endoscopic submucosal dissection (ESD) is a rare but serious complication which sometimes requires emergent surgery. However, reports of its characteristics, including endoscopic imaging and management, are not fully detailed. A 70-year-old woman was referred to our hospital for the treatment of early gastric cancer. On the day of the ESD, hematemesis was observed because of a Mallory-Weiss tear, and a visible vessel in the post-ESD ulcer was additionally treated endoscopically by coagulation. Second-look endoscopic examination on the next day revealed a perforation 3 mm in diameter at the treated vessel in the ulcer. The shape of the perforation was round and the color of the surrounding muscle layer had become whitish. The perforation was closed with endoclips, and decompression of the pneumoperitoneum was performed. The patient was conservatively managed and was discharged 13 days after the ESD. We show endoscopic images of delayed perforation and discuss the mechanism and management of this complication.

  6. Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery

    PubMed Central

    Sanders-Taylor, Chris; Anaizi, Amjad; Kosty, Jennifer; Zimmer, Lee A.; Theodosopoulos, Phillip V.

    2015-01-01

    Objectives Delayed cerebrospinal fluid (CSF) leaks are a complication in transsphenoidal surgery, potentially causing morbidity and longer hospital stays. Sella reconstruction can limit this complication, but is it necessary in all patients? Design Retrospective review. Setting Single-surgeon team (2005–2012) addresses this trend toward graded reconstruction. Participants A total of 264 consecutive patients with pituitary adenomas underwent endoscopic transsphenoidal resections. Sellar defects sizable to accommodate a fat graft were reconstructed. Main outcomes Delayed CSF leak and autograft harvesting. Results Overall, 235 (89%) had reconstruction with autograft (abdominal fat, septal bone/cartilage) and biological glue. Delayed CSF leak was 1.9%: 1.7%, and 3.4% for reconstructed and nonreconstructed sellar defects, respectively (p = 0.44). Complications included one reoperation for leak, two developed meningitis, and autograft harvesting resulted in abdominal hematoma in 0.9% and wound infection in 0.4%. Conclusion In our patients, delayed CSF leaks likely resulted from missed intraoperative CSF leaks or postoperative changes. Universal sellar reconstruction can preemptively treat missed leaks and provide a barrier for postoperative changes. When delayed CSF leaks occurred, sellar reconstruction often allowed for conservative treatment (i.e., lumbar drain) without repeat surgery. We found universal reconstruction provides a low risk of delayed CSF leak with minimal complications. PMID:26225317

  7. A self-assembling matrix-forming gel can be easily and safely applied to prevent delayed bleeding after endoscopic resections

    PubMed Central

    Pioche, Mathieu; Camus, Marine; Rivory, Jérôme; Leblanc, Sarah; Lienhart, Isabelle; Barret, Maximilien; Chaussade, Stanislas; Saurin, Jean-Christophe; Prat, Frederic; Ponchon, Thierry

    2016-01-01

    Background: Endoscopic resections have low morbidity and mortality. Delayed bleeding has been reported in approximately 1 – 15 % of cases, increasing with antiplatelet/anticoagulant therapy or portal hypertension. A self-assembling peptide (SAP) forming a gel could protect the mucosal defect during early healing. This retrospective trial aimed to assess the safety and efficacy of SAP in preventing delayed bleeding after endoscopic resections. Methods: Consecutive patients with endoscopic resections were enrolled in two tertiary referral centers. Patients with a high risk of bleeding (antiplatelet agents, anticoagulation drugs with heparin bridge therapy, and cirrhosis with portal hypertension) were also included. The SAP gel was applied immediately after resection to cover the whole ulcer bed. Results: In total, 56 patients were included with 65 lesions (esophagus [n = 8], stomach [n = 22], duodenum [n = 10], ampullary [n = 3], colon [n = 7], and rectum [n = 15]) in two centers. Among those 65 lesions, 29 were resected in high risk situations (9 uninterrupted aspirin therapy, 6 heparin bridge therapies, 5 cirrhosis and portal hypertension, 1 both cirrhosis and heparin bridge, 3 both cirrhosis and uninterrupted aspirin, 3 large duodenal lesions > 2 cm, and 2 early introduction of clopidogrel at day 1). The resection technique was endoscopic submucosal dissection (ESD) in 40 cases, en bloc endoscopic mucosal resection (EMR) in 16, piecemeal EMR in 6, and ampullectomy in 3. The mean lesion size was 37.9 mm (SD: 2.2 mm) with a mean area of 6.3 cm2 (SD: 3.5 cm2). No difficulty was noted during application. Four delayed overt bleedings occurred (6.2 %) (3 hematochezia, 1 hematemesis) requiring endoscopic hemostasis. The mean hemoglobin drop off was 0.6 g/dL (– 0.6 to 3.1 g/dL). No adverse events occurred. Conclusion: The use of this novel extracellular matrix scaffold may help to reduce post-endoscopic resection

  8. Endoscopic treatment of gastroparesis.

    PubMed

    McCarty, Thomas R; Rustagi, Tarun

    2015-06-14

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

  9. 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

  10. Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis.

    PubMed

    Madhavan, Karthik; Chieng, Lee Onn; Hofstetter, Christoph P; Wang, Michael Y

    2016-02-01

    Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.

  11. Endoscopic calcaneoplasty.

    PubMed

    Jerosch, Joerg

    2015-03-01

    Opinions differ regarding the surgical treatment of posterior calcaneal exostosis. After failure of conservative treatment, open surgical bursectomy and resection of the calcaneal prominence is indicated by many investigators. Clinical studies have shown high rates of unsatisfactory results and complications. Endoscopic calcaneoplasty (ECP) is a minimally invasive surgical option that can avoid some of these obstacles. ECP is an effective procedure for the treatment of patients with posterior calcaneal exostosis. The endoscopic exposure is superior to the open technique and has less morbidity, less operating time, fewer complications, and the disorders can be better differentiated. PMID:25726490

  12. 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 ...

  13. 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

  14. 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

  15. Management of a large mucosal defect after duodenal endoscopic resection

    PubMed Central

    Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Masaki, Tsutomu

    2016-01-01

    Duodenal endoscopic resection is the most difficult type of endoscopic treatment in the gastrointestinal tract (GI) and is technically challenging because of anatomical specificities. In addition to these technical difficulties, this procedure is associated with a significantly higher rate of complication than endoscopic treatment in other parts of the GI tract. Postoperative delayed perforation and bleeding are hazardous complications, and emergency surgical intervention is sometimes required. Therefore, it is urgently necessary to establish a management protocol for preventing serious complications. For instance, the prophylactic closure of large mucosal defects after endoscopic resection may reduce the risk of hazardous complications. However, the size of mucosal defects after endoscopic submucosal dissection (ESD) is relatively large compared with the size after endoscopic mucosal resection, making it impossible to achieve complete closure using only conventional clips. The over-the-scope clip and polyglycolic acid sheets with fibrin gel make it possible to close large mucosal defects after duodenal ESD. In addition to the combination of laparoscopic surgery and endoscopic resection, endoscopic full-thickness resection holds therapeutic potential for difficult duodenal lesions and may overcome the disadvantages of endoscopic resection in the near future. This review aims to summarize the complications and closure techniques of large mucosal defects and to highlight some directions for management after duodenal endoscopic treatment. PMID:27547003

  16. 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) ...

  17. 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

  18. 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

  19. 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

  20. Endoscopic and Clinical Factors Affecting the Prognosis of Colorectal Endoscopic Submucosal Dissection-Related Perforation

    PubMed Central

    Kang, Dong-Uk; Choi, Yunsik; Lee, Ho-Su; Lee, Hyo Jeong; Park, Sang Hyoung; Yang, Dong-Hoon; Yoon, Soon Man; Kim, Kyung-Jo; Ye, Byong Duk; Myung, Seung-Jae; Yang, Suk-Kyun; Kim, Jin-Ho; Byeon, Jeong-Sik

    2016-01-01

    Background/Aims Although colorectal endoscopic submucosal dissection (ESD)-related perforation is not uncommon, the factors affecting clinical outcomes after perforation have not been investigated. This study was designed to investigate the factors influencing the clinical course of ESD-related colon perforation. Methods Forty-three patients with colorectal ESD-related perforation were evaluated. The perforations were classified as endoscopic or radiologic perforations. The patients’ medical records and endoscopic pictures were analyzed. Results The clinical outcomes were assessed by the duration of nil per os, intravenous antibiotics administration, and hospital stays, which were 2.7±1.5, 4.9±2.3, and 5.1±2.3 days, respectively. Multivariate analyses revealed that a larger tumor size, ESD failure, specific endoscopists, and abdominal pain were independently related to a poorer outcome. The time between perforation and clipping was 15.8±25.4 minutes in the endoscopic perforation group. The multivariate analysis of this group indicated that delayed clipping, specific endoscopists, and abdominal pain were independently associated with poorer outcomes. Conclusions Tumor size, ESD failure, abdominal pain, and the endoscopist were factors that affected the clinical outcomes of patients with colorectal ESD-related perforation. The time between the perforation and clipping was an additional factor influencing the clinical course of endoscopic perforation. Decreasing this time period may improve outcomes. PMID:26780090

  1. Endoscopic thoracic sympathectomy

    MedlinePlus

    Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition ... hyperhidrosis . Usually the surgery is used to treat sweating in the palms or face. The sympathetic nerves ...

  2. 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 ...

  3. 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

  4. 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.

  5. 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.

  6. Olecranon extrabursal endoscopic bursectomy.

    PubMed

    Tu, Chen G; McGuire, Duncan T; Morse, Levi P; Bain, Gregory I

    2013-09-01

    Olecranon bursitis is a common clinical problem. It is often managed conservatively because of the high rates of wound complications with the conventional open surgical technique. Conventional olecranon bursoscopy utilizes an arthroscope and an arthroscopic shaver, removing the bursa from inside-out. We describe an extrabursal endoscopic technique where the bursa is not entered but excised in its entirety under endoscopic vision. A satisfactory view is obtained with less morbidity than the open method, while still avoiding a wound over the sensitive point of the olecranon. PMID:23970201

  7. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps.

    PubMed

    Saunders, Brian P; Tsiamoulos, Zacharias P

    2016-08-01

    Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR. PMID:27353401

  8. Endoscopic Removal of a Bullet in Rosenmuller Fossa: Case Report

    PubMed Central

    Burks, Joshua D.; Glenn, Chad A.; Conner, Andrew K.; Bonney, Phillip A.; Sanclement, Jose A.; Sughrue, Michael E.

    2016-01-01

    Fractures of the anterior skull base may occur in gunshot victims and can result in traumatic cerebrospinal fluid (CSF) leak. Less commonly, CSF leaks occur days or even weeks after the trauma occurred. Here, we present the case of a 21-year-old man with a delayed-onset, traumatic CSF leak secondary to a missile injury that left a bullet fragment in the Rosenmuller fossa. The patient was treated successfully with endoscopic, endonasal extraction of the bullet, and repair with a nasal septal flap. Foreign bodies lodged in Rosenmuller fossa can be successfully treated with endoscopic skull base surgery. PMID:27330924

  9. Endoscopic detection of early upper GI cancers.

    PubMed

    Wong Kee Song, Louis-Michel; Wilson, Brian C

    2005-12-01

    The detection of early-stage neoplastic lesions in the upper GI tract is associated with improved survival and the potential for complete endoscopic resection that is minimally invasive and less morbid than surgery. Despite technological advances in standard white-light endoscopy, the ability of the endoscopist to reliably detect dysplastic and early cancerous changes in the upper GI tract remains limited. In conditions such as Barrett's oesophagus, practice guidelines recommend periodic endoscopic surveillance with multiple biopsies, a methodology that is hindered by random sampling error, inconsistent histopathological interpretation, and delay in diagnosis. Early detection may be enhanced by several promising diagnostic modalities such as chromoendoscopy, magnification endoscopy, and optical spectroscopic/imaging techniques, as these modalities offer the potential to identify in real-time lesions that are inconspicuous under conventional endoscopy. The combination of novel diagnostic techniques and local endoscopic therapies will provide the endoscopist with much needed tools that can considerably enhance the detection and management of early stage lesions in the upper GI tract.

  10. 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

  11. 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.

  12. 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

  13. 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).

  14. Successful endoscopic closure of a colonic perforation one day after endoscopic mucosal resection of a lesion in the transverse colon.

    PubMed

    Inoki, Kazuya; Sakamoto, Taku; Sekiguchi, Masau; Yamada, Masayoshi; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Yutaka

    2016-08-16

    A 73-year-old man underwent endoscopic mucosal resection (EMR) of a 20-mm flat elevated lesion on the transverse colon. The morning after the procedure, he started to have severe right upper quadrant pain after his first meal. A computed tomography scan revealed free air and a stomach filled with food. He was diagnosed to have delayed post-EMR intestinal perforation. He underwent emergent colonoscopy and clipping of the perforated site. He was discharged 8 d after the endoscopic closure without the need for surgical intervention. The meal was not the cause of the colon transversum perforation. PMID:27574613

  15. Successful endoscopic closure of a colonic perforation one day after endoscopic mucosal resection of a lesion in the transverse colon

    PubMed Central

    Inoki, Kazuya; Sakamoto, Taku; Sekiguchi, Masau; Yamada, Masayoshi; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Yutaka

    2016-01-01

    A 73-year-old man underwent endoscopic mucosal resection (EMR) of a 20-mm flat elevated lesion on the transverse colon. The morning after the procedure, he started to have severe right upper quadrant pain after his first meal. A computed tomography scan revealed free air and a stomach filled with food. He was diagnosed to have delayed post-EMR intestinal perforation. He underwent emergent colonoscopy and clipping of the perforated site. He was discharged 8 d after the endoscopic closure without the need for surgical intervention. The meal was not the cause of the colon transversum perforation. PMID:27574613

  16. Delayed ejaculation

    MedlinePlus

    Ejaculatory incompetence; Sex - delayed ejaculation; Retarded ejaculation; Anejaculation; Infertility - delayed ejaculation ... include: Religious background that makes the person view sex as sinful Lack of attraction for a partner ...

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

    PubMed

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

    2014-05-01

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

  18. Choledocholithiasis diagnostics - endoscopic ultrasound or endoscopic retrograde cholangiopancreatography?

    PubMed

    Leszczyszyn, Jarosław

    2014-06-01

    It is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis. For decades, endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis. The method is associated with a relatively high rate of complications, including acute pancreatitis, the incidence of which is estimated to range between 0.74% and 1.86%. The mechanism of this ERCP-induced complication is not fully understood, although factors increasing the risk of acute pancreatitis, such as sphincter of Oddi dysfunction, previous acute pancreatitis, narrow bile ducts or difficult catheterization of Vater's ampulla are known. It has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications. Endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter, as opposed to magnetic resonance cholangiography. However, both of these parameters depend on the experience of the performing physician. The use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3. Ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the Vater's ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis. Despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography, the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is

  19. Laparoscopic-endoscopic cooperative surgery for duodenal tumors: a unique procedure that helps ensure the safety of endoscopic submucosal dissection.

    PubMed

    Irino, Tomoyuki; Nunobe, Souya; Hiki, Naoki; Yamamoto, Yorimasa; Hirasawa, Toshiaki; Ohashi, Manabu; Fujisaki, Junko; Sano, Takeshi; Yamaguchi, Toshiharu

    2015-04-01

    A new rendezvous-style surgical technique has been developed to ensure the safety of endoscopic submucosal dissection (ESD) for duodenal tumors. The new technique, called "laparoscopic-endoscopic cooperative surgery (LECS)," combines ESD with laparoscopic, reinforcing, seromuscular suturing. This case series report describes how three patients with a duodenal tumor were safely treated by LECS. ESD was performed by endoscopy, followed by closure of the mucosal defect using seromuscular suturing by laparoscopy. ESD was successfully completed in all patients. Endoscopic findings after suturing revealed that the mucosal defect was closed appropriately and tightly. None of the three patients experienced delayed perforation or stricture after LECS. LECS for extraction of duodenal tumors seems to be feasible and helps to ensure the safety of ESD in the duodenum.

  20. [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

  1. Transanal Endoscopic Microsurgery

    PubMed Central

    Saclarides, Theodore John

    2015-01-01

    Transanal endoscopic microsurgery (TEM) was developed by Professor Gerhard Buess 30 years ago at the dawn of minimally invasive surgery. TEM utilizes a closed proctoscopic system whereby endoluminal surgery is accomplished with high-definition magnification, constant CO2 insufflation, and long-shafted instruments. The end result is a more precise excision and closure compared to conventional instrumentation. Virtually any benign lesion can be addressed with this technology; however, proper patient selection is paramount when using it for cancer. PMID:26491409

  2. Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding: State of the Art

    PubMed Central

    Kitamura, Shinji; Kimura, Tetsuo; Miyamoto, Hiroshi; Takayama, Tetsuji

    2015-01-01

    Nonvariceal upper gastrointestinal (GI) bleeding is one of the most common reasons for hospitalization and a major cause of morbidity and mortality worldwide. Recently developed endoscopic devices and supporting apparatuses can achieve endoscopic hemostasis with greater safety and efficiency. With these advancements in technology and technique, gastroenterologists should have no concerns regarding the management of acute upper GI bleeding, provided that they are well prepared and trained. However, when endoscopic hemostasis fails, endoscopy should not be continued. Rather, endoscopists should refer patients to radiologists and surgeons without any delay for evaluation regarding the appropriateness of emergency interventional radiology or surgery. PMID:25844335

  3. Endoscopic septoplasty: Tips and pearls.

    PubMed

    Pons, Y; Champagne, C; Genestier, L; Ballivet de Régloix, S

    2015-12-01

    This article is designed to provide a step-by-step description of our endoscopic septoplasty technique and discuss its difficulties and technical tips. Endoscopic septoplasty comprises 10 steps: diagnostic endoscopy, subperichondral infiltration, left mucosal incision, dissection of the left subperichondral flap, cartilage incision (0.5 centimetre posterior to the mucosal incision), dissection of the right subperichondral flap, anterior cartilage resection, perpendicular plate dissection, dissection and resection of the maxillary crest, endoscopic revision, mucosal suture and Silastic stents. A satisfactory postoperative result was observed at 3 months in 97% of cases in this series. The main contraindication to endoscopic septoplasty is anterior columellar deviation of the nasal septum requiring a conventional procedure.

  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. Laparoscopic endoscopic cooperative surgery.

    PubMed

    Hiki, Naoki; Nunobe, Souya; Matsuda, Tatsuo; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Yamaguchi, Toshiharu

    2015-01-01

    Laparoscopic and endoscopic cooperative surgery (LECS) is a newly developed concept for tumor dissection of the gastrointestinal tract that was first investigated for local resection of gastric gastrointestinal stromal tumors (GIST). The first reported version of LECS for GIST has been named 'classical LECS' to distinguish it from other modified LECS procedures, such as inverted LECS, a combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET), and non-exposed endoscopic wall-inversion surgery (NEWS). These modified LECS procedures were developed for dissection of malignant tumors which may seed tumor cells into the abdominal cavity. While these LECS-related procedures might prevent tumor seeding, their application is limited by several factors, such as tumor size, location and technical difficulty. Currently, classical LECS is a safe and useful procedure for gastric submucosal tumors without mucosal defects, independent of tumor location, such as proximity to the esophagogastric junction or pyloric ring. For future applications of LECS-related procedures for other malignant diseases with mucosal lesions such as GIST with mucosal defects and gastric cancer, some improvements in the techniques are needed.

  6. Endoscopic lumbar foraminotomy.

    PubMed

    Evins, Alexander I; Banu, Matei A; Njoku, Innocent; Elowitz, Eric H; Härtl, Roger; Bernado, Antonio; Hofstetter, Christoph P

    2015-04-01

    Foraminal stenosis frequently causes radiculopathy in lumbar degenerative spondylosis. Endoscopic transforaminal techniques allow for foraminal access with minimal tissue disruption. However, the effectiveness of foraminal decompression by endoscopic techniques has yet to be studied. We evaluate radiographic outcome of endoscopic transforaminal foraminotomies performed at L3-L4, L4-L5, and L5-S1 on cadaveric specimens. Before and after the procedures, three dimensional CT scans were obtained to measure foraminal height and area. Following the foraminotomies, complete laminectomies and facetectomies were performed to assess for dural tears or nerve root damage. L3-L4 preoperative foraminal height increased by 8.9%, from 2.12±0.13cm to 2.27±0.14cm (p<0.01), and foraminal area increased by 24.8% from 2.21±0.18cm(2) to 2.72±0.19cm(2) (p<0.01). At L4-L5, preoperative foraminal height was 1.87±0.17cm and area was 1.78±0.18cm(2). Endoscopic foraminotomies resulted in a 15.3% increase of foraminal height (2.11±0.15cm, p<0.05) and 44.8% increase in area of (2.51±0.21cm(2), p<0.01). At L5-S1, spondylitic changes caused diminished foraminal height (1.26±0.14cm) and foraminal area (1.17±0.18cm(2)). Postoperatively, foraminal height increased by 41.6% (1.74±0.09cm, p<0.05) and area increased by 98.7% (2.08±0.17cm(2), p<0.01). Subsequent inspection via a standard midline approach revealed one dural tear of an S1 nerve root. Endoscopic foraminotomies allow for effective foraminal decompression, though clinical studies are necessary to further evaluate complications and efficacy.

  7. Endoscopic Management of Dieulafoy's Lesion

    PubMed Central

    Jeon, Hye Kyung

    2015-01-01

    A Dieulafoy's lesion is a vascular abnormality consisting of a large caliber-persistent tortuous submucosal artery. A small mucosal defect with the eruption of this protruding vessel can cause bleeding. In fact, a Dieulafoy's lesion is a relatively rare but potentially life-threatening condition. It accounts for 1% to 2% of cases of acute gastrointestinal bleeding. Although there is no consensus on the treatment of Dieulafoy's lesions; treatment options depend on the mode of presentation, site of the lesion, and available expertise. Endoscopic therapy is usually successful in achieving primary hemostasis, with hemostasis success rates reaching 75% to 100%. Although various therapeutic endoscopic methods are used to control bleeding in Dieulafoy's lesions, the best method for endoscopic intervention is not clear. Combination endoscopic therapy is known to be superior to monotherapy because of a lower rate of recurrent bleeding. In addition, mechanical therapies including hemostatic clipping and endoscopic band ligation are more effective and successful in controlling bleeding than other endoscopic methods. Advances in endoscopic techniques have reduced mortality in patients with Dieulafoy's lesion-from 80% to 8%-and consequently, the need for surgical intervention has been reduced. Currently, surgical intervention is used for cases that fail therapeutic endoscopic or angiographic interventions. PMID:25844338

  8. 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

  9. 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

  10. 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.

  11. 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.

  12. 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

  13. 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

  14. 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

  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. Problems in Endoscopic Sphincteropapillotomy

    PubMed Central

    Yang, Yeong Cheol; Myeong, Jae II; Yeo, Hyang Soon; Park, Hong Bae

    1987-01-01

    Since 1976, endoscopic retrograde cholangiopancreatography(ERCP) has been done in 2,185 cases at Kwangju Christian Hospital in Kwangju, Korea, Between November 1981 and September 1986, endoscopic sphincteropapillotomy(EST) was performed on 194 patients. The results are as follows: 1) Common bile duct stones were found in 171 patients, ascaris in the common bile ducts of 12 patients, ascaris and stones in the common bile duct of 1 patient, clonorchis in the bile ducts of 4 patients, fibrotic stenosis of the periampullary choledochoduodenal fistula in 1 patient, stenosis of the common bile duct in 1 patient and stones in the pancreatic ducts of 4 patients.2) In five cases the stones were extracted under direct vision, in 61 cases the stones were passed in the stool, while in 66 cases stone elimination was confirmed by repeated ERCP or T-tube cholangiography. In 46 cases the stones were not removed, but symptoms and laboratory findings showed marked improvement.3) Complications following EST included 5 cases of bleeding, 1 case of acute pancreatitis with a pancreatic pseudocyst, one death due to sepsis following cholangitis, 5 cases of recurrent cholangitis and 2 cases of recurrent pancreatitis.4) The conditions under which EST became difficult or did not succeed included periampullary diverticula, fibrotic stenosis of ampulla of Vater and stones in the intrahepatic ducts or a gallbladder.5) With improved EST technical maneuverability, we could prevent bleeding and acute pancreatitis with a pancreatic pseudocyst and perform EST successfully in cases with periampullary diverticula. PMID:3154824

  17. [Endoscopic third ventriculostomy: complications and failures].

    PubMed

    Massimi, L; Di Rocco, C; Tamburrini, G; Caldarelli, M; Iannelli, A

    2004-04-01

    Endoscopic third-ventriculostomy (ETV) became the treatment of choice for non-communicating hydrocephalus and its effectiveness is largely reported. On the contrary, specific articles on complications and failures of this technique are very rare and this review aims at supplying further information about it. Therefore, an analysis of the main and up-to-date series is made and exhaustive data about complications and failures of ETV and about their incidence are obtained. The overall frequency rate of complications is 6-20%. Their severity may vary either because of the length of the damage (transient or permanent) or the value of the involved structures (basilar artery, areas of the CNS, hypothalamus) or the importance of the injury (from subclinical sequelae to fatal complications). Moreover, this study showed both the risk that the endoscopic procedure must be suspended (intra-operative failure) and the risk of an early (before 1 month) or delayed (even some years after the intervention) narrowing of the ventriculostomy. The rate of and the reasons for failure have been analysed and the success of a second ETV has been estimated. The results of this analysis suggest that the children proposed for ETV are carefully selected and meticulously studied during the follow-up.

  18. 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.

  19. 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

  20. Anterior endoscopic correction of scoliosis.

    PubMed

    Picetti, George D; Ertl, Janos P; Bueff, H Ulrich

    2002-04-01

    Our technique of anterior endoscopic scoliosis correction demonstrates the ability to perform an anterior approach through a minimally invasive technique with minimal disruption of the local biology. The initial results appear to equal curve correction and fusion rates to those of a formal open anterior approach. Additional benefits are: 1) shortened operative time, 2) lower blood loss, 3) shortened rehabilitation time, 4) less pain, and 5) shortened hospital stays. Endoscopic technique shows great promise in the management of scoliosis curves; however, this is a technically demanding procedure that requires cross-training in endoscopic discectomy and scoliosis management as well as familiarity with the anterior approach anatomy. PMID:12389288

  1. Powered functional endoscopic sinus surgery.

    PubMed

    Krouse, H J; Parker, C M; Purcell, R; Krouse, J H; Christmas, D A

    1997-09-01

    The use of powered instrumentation in functional endoscopic sinus surgery has been a revolutionary development in the surgical treatment of chronic sinusitis. Several studies have demonstrated the safety, efficacy, and ease of use of this new technique. To provide support and coordinate the surgical process in powered functional endoscopic sinus surgery procedures, perioperative nurses must have an appreciation for its specific equipment handling and for appropriate patient care. This article describes a specific protocol that perioperative nurses can use to facilitate efficient and safe surgical environments for patients who undergo powered endoscopic sinus surgery procedures.

  2. Endoscopic magnetic cholecystodigestive anastomoses: personal technique for palliative treatment of distal bile duct obstruction.

    PubMed

    Saveliev, V S; Avaliani, M V; Bashirov, A D

    1993-04-01

    A new type of endoscopic surgery (magnetic cholecystodigestive anastomoses) is presented as an alternative to conventional palliative treatment of mechanical obstruction with icterus located below the bile duct inlet. By means of endoscopic technique, two clinically usable methods of creating delayed magnetic cholecystogastric anastomoses and one modality of implanting cholecystoenteric and enteroenteric anastomosis have been worked out in the experiment conducted on 50 mongrels with mechanical icterus. Ring-shaped or rectangular magnets were implanted in the gallbladder through laparoscopic cholecystostomy. Implantation into the stomach was accompanied by simultaneous gastroscopy. In clinical conditions, four endoscopic cholecystogastric anastomoses and one cholecystoduodenal anastomosis have been performed on patients suffering from malignant obstruction of distal bile duct due to cancer of the head of the pancreas, making any radical surgery pointless. The preliminary results indicate that endoscopic magnetic cholecystodigestive anastomoses can serve as a form of palliative treatment of distal bile duct malignant obstructions. PMID:7686058

  3. 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

  4. Combined Endoscopic and Laparoscopic Surgery

    PubMed Central

    Garrett, Kelly A.; Lee, Sang W.

    2015-01-01

    Benign colon polyps are best treated endoscopically. Colon polyps that are not amenable for endoscopic removals either because they are too large or situated in anatomically difficult locations can pose a clinical dilemma. Traditionally the most common recommendation for these patients has been to offer a colon resection. Although the laparoscopic approach has improved short-term outcomes, morbidities associated with bowel resection are still significant. We may be over treating majority of these patients because of the remote possibility that these polyps may be harboring a cancer. A combined approach using both laparoscopy and colonoscopy (combined endoscopic and laparoscopic surgery) has been described as an alternative to bowel resection in select patients with polyps that cannot be removed endoscopically. Polyp removal using this combined approach may be an effective alternative in select patients. PMID:26491405

  5. Endoscopic imaging of Cerenkov luminescence

    PubMed Central

    Kothapalli, Sri-Rajasekhar; Liu, Hongguang; Liao, Joseph C.; Cheng, Zhen; Gambhir, Sanjiv Sam

    2012-01-01

    We demonstrate feasibility of endoscopic imaging of Cerenkov light originated when charged nuclear particles, emitted from radionuclides, travel through a biological tissue of living subjects at superluminal velocity. The endoscopy imaging system consists of conventional optical fiber bundle/ clinical endoscopes, an optical imaging lens system, and a sensitive low-noise charge coupled device (CCD) camera. Our systematic studies using phantom samples show that Cerenkov light from as low as 1 µCi of radioactivity emitted from 18F-Fluorodeoxyglucose (FDG) can be coupled and transmitted through conventional optical fibers and endoscopes. In vivo imaging experiments with tumor bearing mice, intravenously administered with 18F-FDG, further demonstrated that Cerenkov luminescence endoscopy is a promising new tool in the field of endoscopic molecular imaging. PMID:22741069

  6. 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 ...

  7. Endoscopic approach to achalasia

    PubMed Central

    Müller, Michaela; Eckardt, Alexander J; Wehrmann, Till

    2013-01-01

    Achalasia is a primary esophageal motor disorder. The etiology is still unknown and therefore all treatment options are strictly palliative with the intention to weaken the lower esophageal sphincter (LES). Current established endoscopic therapeutic options include pneumatic dilation (PD) or botulinum toxin injection. Both treatment approaches have an excellent symptomatic short term effect, and lead to a reduction of LES pressure. However, the long term success of botulinum toxin (BT) injection is poor with symptom recurrence in more than 50% of the patients after 12 mo and in nearly 100% of the patients after 24 mo, which commonly requires repeat injections. In contrast, after a single PD 40%-60% of the patients remain asymptomatic for ≥ 10 years. Repeated on demand PD might become necessary and long term remission can be achieved with this approach in up to 90% of these patients. The main positive predictors for a symptomatic response to PD are an age > 40 years, a LES-pressure reduction to < 15 mmHg and/or an improved radiological esophageal clearance post-PD. However PD has a significant risk for esophageal perforation, which occurs in about 2%-3% of cases. In randomized, controlled studies BT injection was inferior to PD and surgical cardiomyotomy, whereas the efficacy of PD, in patients > 40 years, was nearly equivalent to surgery. A new promising technique might be peroral endoscopic myotomy, although long term results are needed and practicability as well as safety issues must be considered. Treatment with a temporary self expanding stent has been reported with favorable outcomes, but the data are all from one study group and must be confirmed by others before definite recommendations can be made. In addition to its use as a therapeutic tool, endoscopy also plays an important role in the diagnosis and surveillance of patients with achalasia. PMID:23951393

  8. [Endoscopic approaches to the orbit].

    PubMed

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

    2010-01-01

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

  9. 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.

  10. [Delayed puberty].

    PubMed

    Antoniazzi, F; Zamboni, G; Tatò, L

    1996-01-01

    Delayed puberty can be defined as the absence of any signs of puberty in subjects that have attained an age at the upper limit (+2DS) for the onset of puberty, that means 13 years in girls and 14 years in boys. The causes of delayed puberty can be classified into three groups, functional temporary impairment in gonadotropin and sex steroid secretion (most frequently constitutional delay of puberty), hypothalamo-pituitary failure with deficiency in gonadotropin secretion, primary gonadal failure with increased gonadotropin levels. The Authors discuss about etiology, diagnostic testing and therapeutic approach in these conditions. The majority of children with delayed puberty are males that have only a constitutional delay of growth and puberty. It is difficult, in teenage years, to distinguish this common and benign condition from true gonadotropin deficiency, in spite of the variety of endocrine tests developed for this purpose. Individuals with constitutional delayed puberty with a bone age greater than 11.5 years, show after triptorelin stimulation an increase in LH capable of distinguishing them from patients with gonadotropin deficiency. In our opinion this could be an important screening test to exclude gonadotropin deficiency in boys with delayed puberty.

  11. Endoscopic stapedotomy: our view point.

    PubMed

    Naik, Chetana; Nemade, Sanjana

    2016-01-01

    Use of endoscope in middle ear surgery is not new, yet there is resistance to its use in stapedotomy. This is due to perceived long learning curve in shifting from conventional microscope to the endoscope and fear of one-handed work. (1) to present a case series of endoscopic stapedotomies and analyze the operative findings. (2) Discuss the merits and demerits of same. 20 patients with otosclerosis underwent stapedotomy over 5 years using 0°, 4 mm nasal endoscope of 18 cm length. Visualization of middle ear structures, surgical steps, operative time, hearing results and complications were analyzed. In all 20 cases, (13 males, 7 females, age: 32.7 years) manipulation of endoscope within the canal was easy facilitating endomeatal incision and elevation of tympanomeatal flap. An optimum exposure of incudo-stapedial joint was obtained in 88.24 % cases. Adequate exposure of crura was obtained in 82.35 % and the footplate in 95 %. The removal of postero-superior bony wall was required in 30 % and chorda tympani mobilization in 25 % of cases. The average operative time was 31 min. Audiometry done at 6 weeks showed, complete air-bone gap closure in 55 %, mild conductive hearing loss (up to 20 dB) in 30 % and mixed hearing loss in 2 cases (BC up to 30 dB and air-bone gap up to 20 dB). In one patient who initially had hearing improvement post operatively, developed moderate conductive hearing loss at 10 weeks. Performing fully endoscopic stapedotomy using a 4 mm nasal endoscope is a feasible option giving excellent visualization with good results.

  12. 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 ...

  13. 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.

  14. Targeted Endoscopic Imaging

    PubMed Central

    Li, Meng; Wang, Thomas D

    2011-01-01

    Summary Endoscopy has undergone explosive technological growth in over recent years, and with the emergence of targeted imaging, its truly transformative power and impact in medicine lies just over the horizon. Today, our ability to see inside the digestive tract with medical endoscopy is headed toward exciting crossroads. The existing paradigm of making diagnostic decisions based on observing structural changes and identifying anatomical landmarks may soon be replaced by visualizing functional properties and imaging molecular expression. In this novel approach, the presence of intracellular and cell surface targets unique to disease are identified and used to predict the likelihood of mucosal transformation and response to therapy. This strategy can result in the development of new methods for early cancer detection, personalized therapy, and chemoprevention. This targeted approach will require further development of molecular probes and endoscopic instruments, and will need support from the FDA for streamlined regulatory oversight. Overall, this molecular imaging modality promises to significantly broaden the capabilities of the gastroenterologist by providing a new approach to visualize the mucosa of the digestive tract in a manner that has never been seen before. PMID:19423025

  15. 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

  16. Percutaneous endoscopic treatment of cholelithiasis.

    PubMed

    Griffith, D P; Rubio, P A; Gleeson, M J

    1990-01-01

    Surgical management of gallstones was first performed successfully in 1878. Over the past decade, several new treatment alternatives have evolved that challenge the supremacy of traditional surgical cholecystectomy. Two endoscopic alternatives, e.g., percutaneous cholecystolithotomy (PCCL) and laparoscopic cholecystectomy (LC) are the latest additions to the growing armamentarium. Our initial experience with PCCL and LC as compared with our traditional cholecystectomy experience shows a 57% reduction in hospital days, a 58% reduction in postoperative analgesic dose, and 50% or more reduction in disabling convalescence in favor of the endoscopic alternatives. A review of the efficacy and morbidity of traditional surgery, peroral drug chemolysis (PDC), shockwave lithotripsy plus PDC, and percutaneous transhepatic lavage with methyl terbutyl ether suggests that the endoscopic alternatives are less morbid than traditional surgery and more efficacious and perhaps less morbid than other non-invasive or minimally invasive alternatives. Both original data and a literature review are presented.

  17. 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.

  18. Recent development in multifunctional endoscope

    NASA Astrophysics Data System (ADS)

    Gono, Kazuhiro

    2008-02-01

    We have developed the novel video endoscope imaging techniques; Narrow band imaging (NBI), Auto-Fluorescence Imaging (AFI), Infra-Red Imaging (IRI) and Endo-Cytoscopy System (ECS). The purpose of these imaging techniques is to emphasize the important tissue features associated with early stage of lesions. We have already launched the new medical endoscope system including NBI, AFI and IRI (EVIS LUCERA SPECTRUM, OLYMPUS MEDICAL SYSTEMS Co., Ltd., Fig.1). Moreover ECS, which has enough magnification to observe cell nuclei on a superficial mucosa under methylene blue dye staining, is the endoscopic instrument with ultra-high optical zoom. In this paper we demonstrate the concepts and the medical efficacy of each technology.

  19. Endoscopic management of diverticular bleeding.

    PubMed

    Rustagi, Tarun; McCarty, Thomas R

    2014-01-01

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

  20. Endoscopic Management of Diverticular Bleeding

    PubMed Central

    Rustagi, Tarun; McCarty, Thomas R.

    2014-01-01

    Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB) with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding. PMID:25548554

  1. 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.

  2. 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

  3. 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

  4. 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

  5. Endoscopic therapy for chronic pancreatitis.

    PubMed

    Dumonceau, Jean-Marc

    2013-10-01

    Endoscopic therapy is recommended as the first-line therapy for painful chronic pancreatitis with an obstacle on the main pancreatic duct (MPD). The clinical response should be evaluated at 6 to 8 weeks. Calcified stones that obstruct the MPD are first treated by extracorporeal shockwave lithotripsy; dominant MPD strictures are optimally treated with a single, large, plastic stent that should be exchanged within 1 year even in asymptomatic patients. Pancreatic pseudocysts for which therapy is indicated and are within endoscopic reach should be treated by endoscopy.

  6. Endoscopic brow lifts uber alles.

    PubMed

    Patel, Bhupendra C K

    2006-12-01

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

  7. 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

  8. Is endoscopic ultrasonography useful for endoscopic submucosal dissection?

    PubMed Central

    Han, Ye; Sun, Siyu; Guo, Jintao; Ge, Nan; Wang, Sheng; Liu, Xiang; Wang, Guoxin; Hu, Jinlong; Wang, Shupeng

    2016-01-01

    Endoscopic submucosal dissection (ESD) is an innovative advance in the treatment of early gastrointestinal (GI) cancer without lymph node metastases and precancerous lesions as it is an effective and safe therapeutic method. ESD has also been a promising therapeutic option for removal of submucosal tumors (SMTs) for improving the completeness of resection of a large lesion. Endoscopic ultrasonography (EUS) can be used to detect the depth of invasion during the preoperative evaluation because of its close proximity to the lesion. EUS-guided fine-needle aspiration can be used to increase the diagnostic accuracy of EUS in determining the malignant lymph node. EUS is considered to be a useful imaging procedure to characterize early GI cancer, which is suspicious for submucosal invasion, and the most accurate procedure for detecting and diagnosing SMTs for further treatment. In the process of ESD, EUS can also be used to detect surrounding blood vessels and the degree of fibrosis; this may be helpful for predicting procedure time and decreasing the risk of bleeding and perforation. EUS-guided injection before ESD renders the endoscopic resection safe and accurate. Therefore, EUS plays an important role in the use of ESD. However, compared to conventional endoscopic staging, EUS sometimes can under or overstage the lesion, and the diagnostic accuracy is controversial. In this review, we summarize the latest research findings regarding the role of EUS in ESD. PMID:27803900

  9. 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

  10. Peroral endoscopic myotomy: An emerging minimally invasive procedure for achalasia

    PubMed Central

    Vigneswaran, Yalini; Ujiki, Michael B

    2015-01-01

    Peroral endoscopic myotomy (POEM) is an emerging minimally invasive procedure for the treatment of achalasia. Due to the improvements in endoscopic technology and techniques, this procedure allows for submucosal tunneling to safely endoscopically create a myotomy across the hypertensive lower esophageal sphincter. In the hands of skilled operators and experienced centers, the most common complications of this procedure are related to insufflation and accumulation of gas in the chest and abdominal cavities with relatively low risks of devastating complications such as perforation or delayed bleeding. Several centers worldwide have demonstrated the feasibility of this procedure in not only early achalasia but also other indications such as redo myotomy, sigmoid esophagus and spastic esophagus. Short-term outcomes have showed great clinical efficacy comparable to laparoscopic Heller myotomy (LHM). Concerns related to postoperative gastroesophageal reflux remain, however several groups have demonstrated comparable clinical and objective measures of reflux to LHM. Although long-term outcomes are necessary to better understand durability of the procedure, POEM appears to be a promising new procedure. PMID:26468336

  11. Endoscopic treatment of juvenile nasopharyngeal angiofibroma.

    PubMed

    Newlands, S D; Weymuller, E A

    1999-01-01

    Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.

  12. 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

  13. Transnasal endoscopic surgery in juvenile nasopharyngeal angiofibroma.

    PubMed

    Kamel, R H

    1996-10-01

    A case of angiofibroma limited to the right posterior nasal cavity, nasopharynx and pterygopalatine fossa was operated upon transnasally under endoscopic control. The tumour was completely excised without complications. Endoscopic follow-up for the next two years and contrast computed tomography (CT) excluded any residual tumour or recurrence. The advantages, limitations and possible complications of this approach are discussed. It seems that in limited lesions of angiofibroma, the option of a transnasal endoscopic approach could be cautiously considered by experienced surgeons.

  14. 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

  15. Technique of transanal endoscopic microsurgery.

    PubMed

    Buess, G; Kipfmüller, K; Hack, D; Grüssner, R; Heintz, A; Junginger, T

    1988-01-01

    Sessile adenomas are predominantly localized in the rectum and lower sigma. Surgical removal is indicated but often implies an invasive surgical procedure. Using conventional transanal surgical techniques, only the lower rectum can be reached and there are high rates of recurrence. The new technique combines an endoscopic view of the rectum under gas insufflation via a stereoscopic telescope with conventional surgical preparation and suturing. Adenomas can be excised using the mucosectomy technique or full-thickness-excision, whereas carcinomas should be excised using full-thickness excision with a sufficient border of healthy mucosa. In carcinomas of the sacral cavity, we remove the retrorectal fat up to the fascia of Waldeyer, including the regional lymph nodes. Transanal endoscopic microsurgery is the most economical and tissue-saving surgical technique for the removal of rectal adenomas and early rectal carcinomas.

  16. External Versus Endoscopic Endonasal Dacryocystorhinostomy.

    PubMed

    Grob, Seanna R; Campbell, Ashley; Lefebvre, Daniel R; Yoon, Michael K

    2015-01-01

    DCR is the treatment of choice for NLDO. External DCR has remained the standard approach since the 1890s. With advances in technique and technology, and more otolaryngologists and ophthalmologists performing endoscopic DCR, more studies have been conducted, some with equivalent success rates between the 2 approaches. Endoscopic endonasal DCR offers the advantages of avoiding a skin incision with similar success rates with experienced surgeons. However, the technique necessitates more surgical equipment, and has a steep learning curve. Both approaches have low complication rates and serious complications are very rare. The decision for the type of approach to use depends on the surgeon’s experience, the patient’s preference or concerns, and the resources available within a particular health system.

  17. Endoscopic imaging of Barrett's esophagus.

    PubMed

    Naveed, Mariam; Dunbar, Kerry B

    2016-03-10

    The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett's esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE. PMID:26981177

  18. Endoscopic ultrasonography-guided hepaticogastrostomy.

    PubMed

    Park, Do Hyun

    2012-04-01

    To date, percutaneous transhepatic biliary drainage (PTBD) has been considered as the usual biliary access after failed endoscopic retrograde cholangiopancreatography (ERCP). Since endoscopic ultrasonography (EUS)-guided bile duct puncture was first described in 1996, sporadic case reports of EUS-guided biliary drainage (EUS-BD) have suggested it as an alternative to PTBD after failed ERCP. The potential benefits of EUS-BD include internal drainage, thus avoiding long-term external drainage in cases where external PTBD drainage catheters cannot be internalized. EUS-guided hepaticogastrostomy (EUS-HG) is one form of EUS-BD. This article describes the indications, techniques, and outcomes of published data on EUS-HG. PMID:22632949

  19. Endoscopic-Assisted Craniosynostosis Surgery

    PubMed Central

    Honeycutt, Johnnie Harrel

    2014-01-01

    Over the last decade, endoscopy has been increasingly utilized in craniosynostosis surgery. In 2006, the author added endoscopy followed by helmet therapy to the treatment of young craniosynostosis patients. Since then, 73 children have been successfully treated utilizing endoscopic techniques with a transfusion rate of 23%. Most children are discharged on the first postoperative day; helmet therapy begins one week later. A helmet is worn for 4 to 6 months with one helmet replacement. Complications were limited to three reoperations to address suboptimal results, and one reoperation for a persisting skull defect. One sagittal sinus injury was addressed successfully, with resolution of a small intrasinus thrombus and no adverse brain sequelae. Although not applicable to every craniosynostosis patient, properly applied endoscopic-assisted craniosynostosis surgery is safe and effective, adding another option to the treatment armamentarium for craniosynostosis. PMID:25210508

  20. Biliary sequelae of endoscopic sphincterotomy.

    PubMed Central

    Greenfield, C.; Cleland, P.; Dick, R.; Masters, S.; Summerfield, J. A.; Sherlock, S.

    1985-01-01

    Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P less than 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear. PMID:2858846

  1. 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.

  2. ENT endoscopic surgical training simulator.

    PubMed

    Edmond, C V; Heskamp, D; Sluis, D; Stredney, D; Sessanna, D; Wiet, G; Yagel, R; Weghorst, S; Oppenheimer, P; Miller, J; Levin, M; Rosenberg, L

    1997-01-01

    This paper describes work in progress on the design and development of a prototype simulator for minimally invasive otolaryngology surgical training. The anatomy of the paranasal sinuses is geometrically complex and dangerously close to the brain and orbits, making this procedure challenging to practice and difficult to learn. We discuss the potential role of computer simulation to enhance and accelerate acquisition of surgical skills. The design goals of the prototype include high-fidelity simulation of the endoscopic imagery and haptic cues of surgical palpation. The prototype enables endoscopic navigation and limited interactive tissue manipulation and dissection tasks on a virtual patient using realistic replicas of surgical tools. We present an overview of the system architecture with a discussion of the technological challenges, design issues and current status of the efforts.

  3. 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

  4. Transoral endoscopic adenoidectomy: initial experience.

    PubMed

    Jong, Y H; Gendeh, B S

    2008-03-01

    Adenoidectomy is a common ENT procedure performed in hospitals in Malaysia. Adenoidectomy is indicated in patients with recurrent adenoiditis, nasal obstruction or sleep apnoea secondary to adenoid hypertrophy when conservative management has failed. Over the years, there are advances in the techniques of adenoidectomy, from the conventional transoral to endoscopic transnasal/transoral adenoidectomy. The purpose of this article is to describe the technique and emphasize the advantages of this procedure to that of the conventional technique.

  5. 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

  6. [Orientation of endoscopic images: rectification by gravity].

    PubMed

    Höller, Kurt; Schneider, Armin; Jahn, Jasper; Gutierrez, Javier; Wittenberg, Thomas; Meining, Alexander; von Delius, Stefan; Hornegger, Joachim; Feussner, Hubertus

    2010-08-01

    A known problem in endoscopic surgery (especially with flexible video endoscopes) is the absence of a stable horizon in endoscopic images displayed on a monitor. With our "ENDOrientation" approach, image rectification, even in non-rigid endoscopic surgery (particularly NOTES), can be realized with a tiny MEMS tri-axial inertial sensor placed on the tip of an endoscope. This sensor measures the impact of gravity on each of the three orthogonal accelerometer axes in real time. After an initial calibration and temporal filtering of these three data steams, the rotation angle of an endoscope can be estimated directly. The achievable sampling rate of the inertial sensor is above the usual endoscopic video frame rate of 25 Hz; the rotation accuracy is approximately one degree. The image rectification can be performed in real time by digitally rotating the endoscopic video signal. Improvements and benefits have been evaluated in animal studies: coordination and movement of different instruments was rated to be much more intuitive with a stable horizon on endoscopic images. The recorded time stamps and position tracks clearly support this observation.

  7. 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

  8. [Endoscopic therapy of acute and chronic pancreatitis].

    PubMed

    Veltzke-Schlieker, W; Adler, A; Abou-Rebyeh, H; Wiedenmann, B; Rösch, T

    2005-02-01

    Endoscopic therapy is valuable for both acute and chronic pancreatitis. Early endoscopic papillotomy appears, in the case of a severe course of acute biliary pancreatitis, to be advantageous. Endoscopic drainage can be considered in cases of acute fluid retention and necrosis as well as subacute, non-healing pancreatitis or cyst development. By acute chronic pancreatitis with strictures or bile duct stones, papillotomy, dilation and stent insertion can lead to an improvement in pain symptoms. An improvement in endo- or exocrine function, however, is not expected. Studies on the endoscopic therapy of pancreatitis are still very limited, and recommendations can usually only be made based on retrospective case series. PMID:15657718

  9. 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

  10. Funding opportunities in endoscopic imaging research.

    PubMed

    Hamilton, Frank A

    2005-07-01

    Advances in gastrointestinal endoscopy have greatly enhanced the clinicians' ability to diagnose and treat many digestive disorders. During the last 30 years, some new therapeutic endoscope techniques have become the standard of care, and other newer evolving technologies are being evaluated. Despite these endoscopic advances, there has been expressed concern that federal funding of endoscopic research has lagged behind other evolving technologic and scientific discoveries. This article provides an overview of the background of one federal agency's attempt to engage the endoscopy community in the research enterprise through a variety of mechanisms of career development, grant support, and endoscopic research and development.

  11. 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

  12. Endoscopic Resection of Vestibular Schwannomas

    PubMed Central

    Setty, Pradeep; D'Andrea, Kenneth P.; Stucken, Emily Z.; Babu, Seilesh; LaRouere, Michael J.; Pieper, Daniel R.

    2015-01-01

    Objective To report our results and the technical details of fully endoscopic resection of vestibular schwannomas. Design Prospective observational study. Setting A single academic institution involving neurosurgery and neurotology. Participants Twelve consecutive patients who underwent fully endoscopic resection of a vestibular schwannoma. Main Outcome Measures Hearing preservation, based on the American Association of Otolaryngology-Head and Neck Surgeons (AAO-HNS) score as well as the Gardener and Robertson Modified Hearing Classification (GR). Facial nerve preservation based on the House-Brackmann (HB) score. Results All patients successfully underwent gross total resection. Facial nerve preservation rate was 92% with 11 of 12 patients retaining an HB score of 1/6 postoperatively. Hearing preservation rate was 67% with 8 of 12 patients maintaining a stable AAO-HNS grade and GR score at follow-up. Mean tumor size was 1.5 cm (range: 1–2 cm). No patients experienced postoperative cerebrospinal fluid leak, infection, or cranial nerve palsy for a complication rate of 0%. Mean operative time was 261.6 minutes with an estimated blood loss of 56.3 mL and average length of hospital stay of 3.6 days. Conclusion A purely endoscopic approach is a safe and effective option for hearing preservation surgery for vestibular schwannomas in appropriately selected patients. PMID:26225307

  13. Master and slave transluminal endoscopic robot (MASTER) for natural orifice transluminal endoscopic surgery (NOTES).

    PubMed

    Phee, S J; Low, S C; Huynh, V A; Kencana, A P; Sun, Z L; Yang, K

    2009-01-01

    Although the flexible endoscopy has been widely used in the medical field for many years, there is still great potential in improving the endoscopist's capability to perform therapeutic tasks. Tentatively, tools for the flexible endoscope have poor maneuverability and limited Degree Of Freedom (DOF). In this paper, we propose a surgical robotic system MASTER (Master And Slave Transluminal Endoscopic Robot). MASTER is a dexterous and flexible master-slave device which can be used in tandem with a conventional flexible endoscope. Using this robotic system, ESD (Endoscopic Submucosal Dissection) and NOTES (Natural Orifice Transluminal Endoscopic Surgery) have been conducted on in vivo and ex vivo animal trials with promising results.

  14. 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

  15. Delaying obsolescence.

    PubMed

    Lawlor, Rob

    2015-04-01

    This paper argues that those who emphasise that designers and engineers need to plan for obsolescence are too conservative. Rather, in addition to planning for obsolescence, designers and engineers should also think carefully about what they could do in order delay obsolescence. They should so this by thinking about the design itself, thinking of ways in which products could be useful and appealing for longer before becoming obsolete, as well thinking about the wider context in terms of the marketing of products, and also the social and legal. The paper also considers objections that these suggestions are unrealistically idealistic, failing to recognise the economic realities. I respond to these objections appealing to research in advertising, psychology, cognitive linguistics, philosophy, history, and economics, as well as drawing on the Statement of Ethical Principles developed by the Royal Academy of Engineering and the Engineering Council. PMID:24792878

  16. 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

  17. [Endoscopic urethrotomy: indications and limitations].

    PubMed

    Miñana López, Bernardino

    2014-01-01

    Endoscopic urethrotomy is a simple, reproducible, highly widespread technique that enables an appropriate management of patients with urethral stenosis, if the indication is well established. Determinants of success of this procedure are stenosis length, site, number, degree of spongiofibrosis and previous treatments. The best results would be obtained in single, short bulbar stenoses with limited spongiofibrosis, in which it may be the first choice. Its main limitation is the fact that the procedure itself is a controlled intentional trauma the result of which depends on multiple variables, including the technique employed.

  18. 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

  19. Hamlet's delay.

    PubMed

    Dendy, E B

    2001-01-01

    This paper raises a question about Freud's understanding of Hamlet and offers a fresh psychoanalytic perspective on the play, emphasizing the psychological use made of Hamlet by the audience. It suggests Hamlet and Claudius both serve as sacrificial objects, scapegoats, for the audience, embodying, through a mechanism of both identification and disidentification, the fulfillment, punishment, and renunciation of the audience's forbidden (i.e. Oedipal) wishes. The play is thus seen to represent unconsciously a rite of sacrifice in which both Claudius and Hamlet, both the father and the son, are led, albeit circuitously, to the slaughter. The need for delay on the part of Hamlet is thus seen to arise not merely from Hamlet's psychology, whatever the audience may project onto it, but ultimately from the function (both sadistic and defensive) that the sacrificial spectacle, the play as a whole, serves for the audience. The paper also speculates somewhat on the role of tragic heroes and heroines in general, and points to the unconscious collusion that permits author and audience to make use of them. Finally, in an addendum, the paper discusses the work of René Girard, a nonpsychoanalytic thinker whose ideas nonetheless are somewhat similar to those presented here. PMID:12102022

  20. Novel Endoscopic Management of Obesity.

    PubMed

    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

  1. 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

  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. Endoscopic approaches to treatment of achalasia

    PubMed Central

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

    2013-01-01

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

  4. 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

  5. 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

  6. Endoscopic sinus surgery: evolution and technical innovations.

    PubMed

    Govindaraj, S; Adappa, N D; Kennedy, D W

    2010-03-01

    Prior to the introduction of functional endoscopic sinus surgery, several surgeons had begun to use telescopes to perform surgical procedures in the nose and sinuses. However, the central concepts of functional endoscopic sinus surgery evolved primarily from Messerklinger's endoscopic study of mucociliary clearance and endoscopic detailing of intranasal pathology. The popularity of a combination of endoscopic ethmoidectomy plus opening of secondarily involved sinuses grew rapidly during the latter part of the twentieth century, and endoscopic intranasal techniques began to expand to deal with pathology other than inflammation. We present a review of the evolution of knowledge regarding the pathogenesis of inflammatory sinus disease since that point in time, and of the impact that this has had on the management of inflammatory sinus disease. We also detail the technological advances that have allowed endoscopic intranasal techniques to expand and successfully treat other pathology, including skull base and orbital disease. In addition, we describe evolving technologies which may further influence development within this field. PMID:19930748

  7. 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

  8. Endoscopic Management of Peptic Ulcer Bleeding

    PubMed Central

    Kim, Joon Sung; Park, Sung Min

    2015-01-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods. PMID:25844337

  9. 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

  10. Endoscopic management of peptic ulcer bleeding.

    PubMed

    Kim, Joon Sung; Park, Sung Min; Kim, Byung-Wook

    2015-03-01

    Acute upper gastrointestinal bleeding is a common medical emergency around the world and the major cause is peptic ulcer bleeding. Endoscopic treatment is fundamental for the management of peptic ulcer bleeding. Despite recent advances in endoscopic treatment, mortality from peptic ulcer bleeding has still remained high. This is because the disease often occurs in elderly patients with frequent comorbidities and are taking ulcerogenic medications. Therefore, the management of peptic ulcer bleeding is still a challenge for clinicians. This article reviews the various endoscopic methods available for management of peptic ulcer bleeding and the techniques in using these methods.

  11. 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

  12. [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

  13. Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal.

    PubMed

    Vuyyuru, Sreedhar; Ravuri, Sreenivas R; Tandra, Vamsidhar R; Panigrahi, Manas K

    2009-07-01

    We describe the extrusion of a ventriculo peritoneal shunt tube from the anus into a 6-year-old boy following the placement of a ventriculo peritoneal shunt for postoperative periventricular tumor-induced hydrocephalus. He was admitted with a complaint of extrusion of a tube through anus on and off during bowel evacuation. He was evaluated with an X-ray of the abdomen which was showing a coiled tube in descending and sigmoid colon, confirmed by sigmoidoscopy. The proximal end was exposed for external ventricular drainage and distal end was removed endoscopically. The patient was watched for peritonitis and managed conservatively. The proximal end of the tube was removed after 5 days of external ventricular drainage and after ruling out ventriculitis and meningitis. Bowel perforation by a ventriculo peritoneal tube is a rare complication. Diagnosis is often difficult and delayed. Most of the bowel perforation is seen in young patients. PMID:21887196

  14. Refractory strictures despite steroid injection after esophageal endoscopic resection

    PubMed Central

    Hanaoka, Noboru; Ishihara, Ryu; Uedo, Noriya; Takeuchi, Yoji; Higashino, Koji; Akasaka, Tomofumi; Kanesaka, Takashi; Matsuura, Noriko; Yamasaki, Yasushi; Hamada, Kenta; Iishi, Hiroyasu

    2016-01-01

    Background: Although steroid injection prevents stricture after esophageal endoscopic submucosal dissection (ESD), some patients require repeated sessions of endoscopic balloon dilation (EBD). We investigated the risk for refractory stricture despite the administration of steroid injections to prevent stricture in patients undergoing esophageal ESD. Refractory stricture was defined as the requirement for more than three sessions of EBD to resolve the stricture. In addition, the safety of steroid injections was assessed based on the rate of complications. Patients and methods: We analyzed data from 127 consecutive patients who underwent esophageal ESD and had mucosal defects with a circumferential extent greater than three-quarters of the esophagus. To prevent stricture, steroid injection was performed. EBD was performed whenever a patient had symptoms of dysphagia. Results: The percentage of patients with a tumor circumferential extent greater than 75 % was significantly higher in those with refractory stricture than in those without stricture (P = 0.001). Multivariate analysis adjusted for age, sex, history of radiation therapy, tumor location, and tumor diameter showed that a tumor circumferential extent greater than 75 % was an independent risk factor for refractory stricture (adjusted odds ratio [OR] 5.49 [95 %CI 1.91 – 15.84], P = 0.002). Major adverse events occurred in 3 patients (2.4 %): perforation during EBD in 2 patients and delayed perforation after EBD in 1 patient. The patient with delayed perforation underwent esophagectomy because of mediastinitis. Conclusions: A tumor circumferential extent greater than 75 % is an independent risk factor for refractory stricture despite steroid injections. The development of more extensive interventions is warranted to prevent refractory stricture. PMID:27004256

  15. Advantages of disposable endoscopic accessories.

    PubMed

    Petersen, B T

    2000-04-01

    Despite the prevailing emphasis on falling reimbursements and cost containment, the use of disposable endoscopic accessories has grown tremendously. They offer simplicity of use, certain sterility, and reduced labor costs in exchange for higher purchase costs per procedure and the burden of waste disposal. Disposable accessories provide greater variety, complexity, and utility. They carry a cost burden that may be acceptable when the devices are difficult to reprocess, when they incorporate features that justify the added cost, or when their unit cost approaches purchase plus reprocessing costs for reusable alternatives, such as for biopsy forceps. Units with small volumes may prefer the ease of disposable accessories independent of relative cost issues, while large high-volume units may need to evaluate cost data more carefully to maintain sustainable practices.

  16. Importance of repeat angiography in the diagnosis of iatrogenic anterior cerebral artery territory pseudoaneurysm following endoscopic sinus surgery.

    PubMed

    Munich, Stephan A; Cress, Marshall C; Rangel-Castilla, Leonardo; Krishna, Chandan; Siddiqui, Adnan H; Snyder, Kenneth V

    2015-05-15

    Iatrogenic intracranial pseudoaneurysm formation and rupture are rare complications following endoscopic sinus surgery. Given the propensity for devastating neurologic injury after a relatively routine procedure, swift diagnosis and treatment is essential. The authors present a patient who experienced bifrontal intracranial hemorrhage and subarachnoid hemorrhage due to a ruptured iatrogenic frontopolar artery pseudoaneurysm caused during routine endoscopic sinus surgery. The pseudoaneurysm was not present on initial angiograms but became apparent radiographically 19 days after the endoscopic procedure. Endovascular treatment consisted of coil and Onyx embolization for sacrifice of the parent vessel proximal to the lesion. Early recognition of iatrogenic intracranial vascular injury is important to allow for rapid treatment. Initial radiographic studies may be unreliable in excluding the presence of a pseudoaneurysm so delayed repeat angiographic assessment is necessary, particularly in the presence of a high index of clinical suspicion. Endovascular techniques may provide an effective and safe option for the treatment of iatrogenic anterior cerebral artery distribution pseudoaneurysms.

  17. Peroral endoscopic myotomy for esophageal achalasia

    PubMed Central

    Inoue, Haruhiro; Ikeda, Haruo; Sato, Hiroki; Sato, Chiaki; Hokierti, Chananya

    2014-01-01

    Peroral endoscopic myotomy (POEM) is one of the alternative treatment for achalasia. Due to concept of natural orifice transluminal endoscopic surgery (NOTES), it becomes popular and widely accepted. With the endoluminal technique, submucosal tunnel was created followed by endoscopic myotomy. POEM is not only indicated in classical achalasia but also other abnormal esophageal motility disorders. Moreover, failures of endoscopic treatment or surgical attempted cases are not contraindicated for POEM. The second attempted POEM is also safe and technically feasible. Even though the legend of success of POEM is fruitful, the possible complications are very frightened. Good training and delicate practice will reduce rate of complications. This review provides a summary of current state-of-the-art of POEM, including indication equipments, technique and complications. This perfect procedure may become the treatment of choice of achalasia and some esophageal motility disorders in the near future. PMID:25333007

  18. Advances in endoscopic imaging in ulcerative colitis.

    PubMed

    Tontini, Gian Eugenio; Pastorelli, Luca; Ishaq, Sauid; Neumann, Helmut

    2015-01-01

    Modern strategies for the treatment of ulcerative colitis require more accurate tools for gastrointestinal imaging to better assess mucosal disease activity and long-term prognostic clinical outcomes. Recent advances in gastrointestinal luminal endoscopy are radically changing the role of endoscopy in every-day clinical practice and research trials. Advanced endoscopic imaging techniques including high-definition endoscopes, optical magnification endoscopy, and various chromoendoscopy techniques have remarkably improved endoscopic assessment of ulcerative colitis. More recently, optical biopsy techniques with either endocytoscopy or confocal laser endomicroscopy have shown great potential in predicting several histological changes in real time during ongoing endoscopy. Here, we review current applications of advanced endoscopic imaging techniques in ulcerative colitis and present the most promising upcoming headways in this field. PMID:26365308

  19. 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

  20. Endoscopically Based Endonasal and Transnasal Lasersurgery

    PubMed Central

    Scherer, Hans; Hopf, Juergen U. G.; Hopf, Marietta

    2001-01-01

    The endoscopically based endonasal and transnasal laser surgery is a surgical procedure, which offers the ENT-specialist a safe and effective method to cure or to improve a number of diseases of the upper and middle airways. Coagulative lasers are used in contact and noncontact mode. Their light is mainly absorbed by hemoglobin but rarely by water. The laser–tissue interaction is performed via flexible glass fibers. For the delivery of the laser beam we use specially designed applicator sheaths, which incorporate the endoscope, the laser fiber and the suction channel. The procedure is controlled online via the endoscopic image on the monitor (“video-endoscopy”). The patient suffers less trauma using this treatment compared to the standard endoscopic surgery and the procedure is much quicker. Pre- and post-operative rhinomanometric and rhinoresistometric measurements reveal that the air flow rate of the nose can be improved effectively. PMID:18493555

  1. 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

  2. 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

  3. Reutilization of accessories in gastrointestinal endoscopic practice.

    PubMed

    Haber, G

    2000-10-01

    The key issues that determine the decision between reusable versus disposable accessories are cost and functionality. In most health-care systems the availability and dissemination of endoscopic services relates directly to the resources (i.e. budget) of that system. Given the limitations of health-care budgets, access to endoscopic services will depend upon the cost efficiency of endoscopic practice. The onus on endoscopists and health-care providers, therefore, is to meticulously evaluate the necessary steps for safe reutilization of accessories. This paper addresses the principles of reuse, quality assurance and particularly disinfection practices. Any change to a more costly disposable accessory policy must bear the responsibility of denied access to endoscopic services in a system with finite resources.

  4. 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

  5. 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

  6. Ultrasound-Assisted Endoscopic Carpal Tunnel Release.

    PubMed

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

    2016-06-01

    Various surgical procedures for carpal tunnel syndrome exist, such as open release, ultrasound-guided percutaneous release, and endoscopic release. Postoperative pain, scarring, and slow recovery to normal function are reported complications of open release. Damage to vessels and the median nerve and its branches underlying the transverse carpal ligament is a reported complication of ultrasound-guided percutaneous release. Damage to the superficial palmar arch and incomplete release are reported complications of endoscopic release. By performing endoscopic carpal tunnel release with ultrasound assistance, we could visualize neurovascular structures directly with the endoscope and also indirectly with ultrasound to minimize complications. We could also evaluate the morphologic changes of the median nerve dynamically before and after the release. We discuss the technique for this procedure and outline pearls and pitfalls for success. PMID:27656366

  7. 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

  8. 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

  9. Three-dimensional shape measurements using endoscopes

    NASA Astrophysics Data System (ADS)

    Su, Wei-Hung; Hsu, Tzu-Chien; Kuo, Cho-Yo

    2015-08-01

    We present a fringe projection system embedded into an endoscope to describe the absolute shape of an inspected object. A fringe pattern generated by launching incoherent light waves into a volume hologram is projected on the inspected surface. The endoscope observes the projected fringes at another point of view. Fringes on the obtained image are deformed both by the topography of the object, and are analyzable to retrieve the 3D shape.

  10. Delayed Gastric Emptying after Living Donor Hepatectomy for Liver Transplantation

    PubMed Central

    Griesemer, Adam D.; Parsons, Ronald F.; Graham, Jay A.; Emond, Jean C.; Samstein, Benjamin

    2014-01-01

    Delayed gastric emptying is a significant postoperative complication of living donor hepatectomy for liver transplantation and may require endoscopic or surgical intervention in severe cases. Although the mechanism of posthepatectomy delayed gastric emptying remains unknown, vagal nerve injury during intraoperative dissection and adhesion formation postoperatively between the stomach and cut liver surface are possible explanations. Here, we present the first reported case of delayed gastric emptying following fully laparoscopic hepatectomy for living donor liver transplantation. Additionally, we also present a case in which symptoms developed after open right hepatectomy, but for which dissection for left hepatectomy was first performed. Through our experience and these two specific cases, we favor a neurovascular etiology for delayed gastric emptying after hepatectomy. PMID:25610698

  11. 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

  12. Endoscopic Management of Gastrointestinal Leaks and Fistulae.

    PubMed

    Willingham, Field F; Buscaglia, Jonathan M

    2015-10-01

    Gastrointestinal leaks and fistulae can be serious acute complications or chronic morbid conditions resulting from inflammatory, malignant, or postsurgical states. Endoscopic closure of gastrointestinal leaks and fistulae represents major progress in the treatment of patients with these complex presentations. The main goal of endoscopic therapy is the interruption of the flow of luminal contents across a gastrointestinal defect. In consideration of the proper endoscopic approach to luminal closure, several basic principles must be considered. Undrained cavities and fluid collections must often first be drained percutaneously, and the percutaneous drain provides an important measure of safety for subsequent endoscopic luminal manipulations. The size and exact location of the leak/fistula, as well as the viability of the surrounding tissue, must be defined. Almost all complex leaks and fistulae must be approached in a multidisciplinary manner, collaborating with colleagues in nutrition, radiology, and surgery. Currently, gastrointestinal leaks and fistulae may be managed endoscopically by using 1 or more of the following modalities: stent placement, clip closure (including through-the-scope clips and over-the-scope devices), endoscopic suturing, and the injection of tissue sealants. In this article, we discuss these modalities and review the published outcomes data regarding each approach as well as practical considerations for successful closure of luminal defects.

  13. 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

  14. 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.

  15. Upper non-variceal gastrointestinal bleeding - review the effectiveness of endoscopic hemostasis methods

    PubMed Central

    Szura, Mirosław; Pasternak, Artur

    2015-01-01

    Upper non-variceal gastrointestinal bleeding is a condition that requires immediate medical intervention and has a high associated mortality rate (exceeding 10%). The vast majority of upper gastrointestinal bleeding cases are due to peptic ulcers. Helicobacter pylori infection, non-steroidal anti-inflammatory drugs and aspirin are the main risk factors for peptic ulcer disease. Endoscopic therapy has generally been recommended as the first-line treatment for upper gastrointestinal bleeding as it has been shown to reduce recurrent bleeding, the need for surgery and mortality. Early endoscopy (within 24 h of hospital admission) has a greater impact than delayed endoscopy on the length of hospital stay and requirement for blood transfusion. This paper aims to review and compare the efficacy of the types of endoscopic hemostasis most commonly used to control non-variceal gastrointestinal bleeding by pooling data from the literature. PMID:26421105

  16. The Endoscopic Treatment of Carpal Tunnel Syndrome as an Outpatient Procedure

    PubMed Central

    Cameron, E. A.; Klausmann, H. G.; Erggelet, C.; Krämer, J.

    1998-01-01

    From September 1995 to July 1996 50 patients were treated for carpal tunnel syndrome as outpatients by endoscopic release in the rooms of an orthopaedic surgeon (two-portal-technique). The average age was 51.3 years (27–61 years). The average length of symptoms was 43 months, the postoperative time off work averaged 27 days. Six months postoperatively wasting of the thenar persisted in 2 out of 16 patients, a positive Tinel's sign in 1 out of 46 patients and delayed median nerve conduction in 2 out of 48 presenting these symptoms preoperatively. At 6 months the average handgrip strength had recovered to 109% of the preoperative value. One out of 49 patients still presented paresthesia and 1 out of 50 nocturnal dysesthesia. There were minor complications in 7 patients (14%), only one patient requires further treatment. We conclude that endoscopic carpal tunnel release done on outpatients in a private surgery can be reliable, safe and cost efficient. PMID:18493471

  17. Application Of Endoscopic Lasers For Operations In Gastro-Intestinal Tract

    NASA Astrophysics Data System (ADS)

    Skobelkin, O. K.; Saphronov, A. M.; Shapovalov, A. M.; Zaharov, P. I.

    1988-06-01

    We have described our experience in the application of high energy argon and Nd:YAG lasers for endoscopic surgical manipulations. Laser was used for the removal of polyps with a wide base, villi tumours in colon, for the elimination of scar strictures in colon anastomosis, for the formation of primary-delayed colon anastomosis and for the removal of timoral stenosis in esophagus and in colon. Laser therapy has certain advantages over other endoscopic manipulations: long-term and immediate results are better. One can use this therapy in combination with others (radial therapy, surgical treatment). We have worked out a classification of polyps and stenosing tumours in the digestive system to determine indications for laser endoscopy and to choose the best parameters of laser irradiation.

  18. Endoscopic mucosal resection with circumferential incision for treatment of rectal carcinoid tumours

    PubMed Central

    2014-01-01

    Background Endoscopic mucosal resection (EMR) is simple and quick and has low complication rates. However, the disadvantage of local recurrence or remnant rate limits the use of this technique. We aimed to analyse the outcomes of conventional EMR and EMR with circumferential incision (CIEMR), a simplified modification of EMR, in the endoscopic treatment of rectal carcinoid tumours. Methods A total of 59 consecutive patients with rectal carcinoid tumours without regional lymph node enlargement confirmed by endoscopic ultrasonography were included in the study. These patients underwent endoscopic treatment from January 2009 to September 2011 and were randomly designated into CIEMR (n = 31) or EMR group (n = 28). En bloc resection rate, pathological complete resection rate, procedure time, complications and follow-up outcomes were analysed. Results The en bloc resection rate was not significantly different between the CIEMR and EMR groups (100% versus 96.55%, P > 0.05). The pathological complete resection rate was higher in the CIEMR group than in the EMR group (96.7% versus 82.14%, P < 0.05). The overall complication rate, delayed bleeding and procedure time were not significantly different between the two groups. No recurrence was observed in either the EMR or CIEMR group. Conclusions CIEMR optimises the procedure of EMR and simplifies the technique of endoscopic submucosal dissection; thus, it has a better histologically complete resection rate and more acceptable complication rate than EMR. Thus, CIEMR may be preferable to conventional EMR for resection of rectal carcinoid tumours less than 15 mm. PMID:24472342

  19. Endoscopic management of nonlifting colon polyps.

    PubMed

    Friedland, Shai; Shelton, Andrew; Kothari, Shivangi; Kochar, Rajan; Chen, Ann; Banerjee, Subhas

    2013-01-01

    Background and Study Aims. The nonlifting polyp sign of invasive colon cancer is considered highly sensitive and specific for cancer extending beyond the mid-submucosa. However, prior interventions can cause adenomas to become nonlifting due to fibrosis. It is unclear whether nonlifting adenomas can be successfully treated endoscopically. The aim of this study was to evaluate outcomes in a referral practice incorporating a standardized protocol of attempted endoscopic resection of nonlifting lesions previously treated by biopsy, polypectomy, surgery, or tattoo placement. Patients and Methods. Retrospective review of patients undergoing colonoscopy by one endoscopist at two hospitals found to have nonlifting lesions from prior interventions. Lesions with biopsy proven invasive cancer or definite endoscopic features of invasive cancer were excluded. Lesions ≥ 8 mm were routinely injected with saline prior to attempted endoscopic resection. Polypectomy was performed using a stiff snare, followed by argon plasma coagulation (APC) if necessary. Results. 26 patients each had a single nonlifting lesion with a history of prior intervention. Endoscopic resection was completed in 25 (96%). 22 required snare resection and APC. 1 patient had invasive cancer and was referred for surgery. The recurrence rate on follow-up colonoscopy was 26%. All of the recurrences were successfully treated endoscopically. There was 1 postprocedure bleed (4%), no perforations, and no other complications. Conclusions. The majority of adenomas that are nonlifting after prior interventions can be treated successfully and safely by a combination of piecemeal polypectomy and ablation. Although recurrence rates are high at 26%, these too can be successfully treated endoscopically. PMID:23761952

  20. Peroral endoscopic pyloromyotomy accelerates gastric emptying in healthy pigs: proof of concept

    PubMed Central

    Geyl, Sophie; Legros, Romain; Charissou, Aurélie; Mesturoux, Laura; Couquet, Claude-Yves; Carrier, Paul; Brayette, Anaïs; El-Ouafi, Zora; Loustaud-Ratti, Veronique; Sautereau, Denis; Monteil, Jacques; Jacques, Jérémie

    2016-01-01

    Introduction: Gastroparesis, or delayed gastric emptying, can be diagnosed with gastric emptying scintigraphy. Manometric studies of patients with gastroparesis show increased pyloric tone (pylorospasm). Among the recent endoscopic therapies for pylorospasm is peroral endoscopic pylorotomy (POP). In this study, we explored the effect of POP on gastric emptying in healthy pigs. Material and methods: Four mini-pigs underwent POP following general anaesthesia. The mucosal entrance was situated 5 cm above the pylorus. POP was performed through a submucosal tunnel dissection. The duration of gastric emptying was assessed by scintigraphy before and after the procedure. The pigs were then euthanised for necropsy and pathologic assessment of the pylorus. Results: The mean duration of the procedure was 55 (± 4 SD) min. All surgeries were performed in their entirety with 100 % feasibility. There were no cases of bleeding. The one case of perforation had no clinical significance. The duration of gastric emptying was 2.22-fold shorter after POP compared with before POP (T½ post-POP = 84.5 [± 35.7 SD] min vs. T½ pre-POP = 188.4 [± 87.3 SD] min; P = 0.029). In agreement with the endoscopic observations, sectioning of the pyloric muscle in each pig was histologically complete. Conclusion: The efficacy of the procedure provides indirect proof of the involvement of the pyloric ring in delayed gastric emptying and suggests new therapies for patients with gastroparesis. Our protocol combining gastric emptying scintigraphy and POP validated the use of anaesthetised mini-pigs as a learning and training model for POP or other endoscopic/surgical procedures related to gastric emptying. PMID:27556100

  1. [Endoscopic ultrasonography elastography in gastroenterology].

    PubMed

    Rustemović, Nadan; Opacić, Milorad; Cuković-Cavka, Silvija

    2009-12-01

    Endoscopic ultrasonography (EUS) elastography is a new technique for detecting the elastic properties of examined tissues during real time ultrasonography. The method is a very valuable tool for the diagnosis and evaluation of pathologic processes affecting the gastrointestinal tract and its adjacent organs. It represents a major advance in the diagnosis and staging of gastrointestinal malignancies, especially pancreatic carcinoma. EUS also provides guidance for fine needle aspiration (FNA) of undiagnosed masses and lymph nodes. Establishing the diagnosis of Crohn's disease or ulcerative colitis is sometimes very difficult. When inflammatory bowel disease (IBD) is confined to the colon, there is a lack of diagnostic tools for distinction between Crohn's colitis and ulcerative colitis, which is especially important in definitive phenotyping before surgical decision. Our ongoing studies emphasize the role of EUS elastography in the diagnosis of inflammatory bowel disease phenotype and primary sclerosing cholangitis. As there are no literature data on this issue, we recommend further investigations in this promising new area of research. PMID:20235372

  2. Endoscopic treatment of prepatellar bursitis.

    PubMed

    Huang, Yu-Chih; Yeh, Wen-Lin

    2011-03-01

    Operative treatment of prepatellar bursitis is indicated in intractable bursitis. The most common complication of surgical treatment for prepatellar bursitis is skin problems. For traumatic prepatellar bursitis, we propose a protocol of outpatient endoscopic surgery under local anaesthesia. From September 1996 to February 2001, 60 cases of failed nonoperative treatment for prepatellar bursitis were included. The average age was 33.5 ± 11.1 years (range 21-55). The average operation duration was 18 minutes. Two to three mini-arthroscopic portals were used in our series. No sutures or a simple suture was needed for the portals after operation. After follow-up for an average of 36.3 months, all patients are were symptom-free and had regained knee function. None of the population had local tenderness or hypo-aesthesia around their wound. Their radiographic and sonographic examinations showed no recurrence of bursitis. Outpatient arthroscopic bursectomy under local anaesthesia is an effective procedure for the treatment of post-traumatic prepatellar bursitis after failed conservative treatments. Both the cosmetic results and functional results were satisfactory. PMID:20521045

  3. Endoscopic Treatment of Gastrointestinal Perforations, Leaks, and Fistulae.

    PubMed

    Rustagi, Tarun; McCarty, Thomas R; Aslanian, Harry R

    2015-01-01

    Gastrointestinal leaks and fistulae are common postoperative complications, whereas intestinal perforation more commonly complicates advanced endoscopic procedures. Although these complications have classically been managed surgically, there exists an ever-expanding role for endoscopic therapy and the involvement of advanced endoscopists as part of a multidisciplinary team including surgeons and interventional radiologists. This review will serve to highlight the innovative endoscopic interventions that provide an expanding range of viable endoscopic approaches to the management and therapy of gastrointestinal perforation, leaks, and fistulae.

  4. 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.

  5. Laparoscopic-Assisted Percutaneous Endoscopic Transgastrostomy Jejunostomy

    PubMed Central

    Dimofte, Mihail-Gabriel; Nicolescu, Simona; Ristescu, Irina; Lunca, Sorinel

    2014-01-01

    Background and Objectives: New therapeutic protocols for patients with end-stage Parkinson disease include a carbidopa/levodopa combination using continuous, modulated enteral administration via a portable pump. The typical approach involves a percutaneous endoscopic transgastrostomy jejunostomy (PEG-J), which requires a combination of procedures designed to ensure that no organ is interposed between the abdominal wall and the gastric surface. Lack of transillumination in maximal endoscopic light settings is a major contraindication for PEG-J, and we decided to use a different approach to establish enteric access for long-term medication delivery via pump, using a minimally invasive procedure. Methods: In all patients, we performed a laparoscopic-assisted percutaneous transgastrostomy jejunostomy (LAPEG-J) after an unsuccessful endoscopic transillumination. Results: Five patients with end-stage Parkinson disease were referred to our department after successful therapeutic testing with administration of levodopa/carbidopa via naso-jejunal tube. All patients failed the endoscopic transillumination during the endoscopic procedure and were considered for LAPEG-J. In all patients, the LAPEG-J procedure was uneventful. The most common reason identified for failed transillumination was a high position of the stomach, followed by interposition of the liver or colon between the stomach and anterior abdominal wall. There were no complications regarding the LAPEG-J procedure, and all patients were discharged during the second postprocedural day. Conclusions: LAPEG-J provides a simple and safe option for placing a jejunostomy after an unsuccessful PEG-J attempt. PMID:25489214

  6. Endoscopic Management of Gastroesophageal Reflux Disease: Revisited

    PubMed Central

    Nabi, Zaheer; Reddy, D. Nageshwar

    2016-01-01

    Gastroesophageal reflux disease (GERD) is defined by the presence of troublesome symptoms resulting from the reflux of gastric contents. The prevalence of GERD is increasing globally. An incompetent lower esophageal sphincter underlies the pathogenesis of GERD. Proton pump inhibitors (PPIs) form the core of GERD management. However, a substantial number of patients do not respond well to PPIs. The next option is anti-reflux surgery, which is efficacious, but it has its own limitations, such as gas bloating, inability to belch or vomit, and dysphagia. Laparoscopic placement of magnetic augmentation device is emerging as a useful alternative to conventional anti-reflux surgery. However, invasiveness of a surgical procedure remains a concern for the patients. The proportion of PPI non-responders or partial responders who do not wish for anti-reflux surgery defines the ‘treatment gap’ and needs to be addressed. The last decade has witnessed the fall and rise of many endoscopic devices for GERD. Major endoscopic strategies include radiofrequency ablation and endoscopic fundoplication devices. Current endoscopic devices score high on subjective improvement, but have been unimpressive in objective improvement like esophageal acid exposure. In this review, we discuss the current endoscopic anti-reflux therapies and available evidence for their role in the management of GERD. PMID:27744659

  7. 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.

  8. [Preventive effect of postoperative disinfection of endoscope on bacterial adhesion to endoscope].

    PubMed

    Uwagawa, T; Okabe, N; Matsumoto, T; Kurihara, H; Miyamoto, S; Tujihara, Y; Takahashi, T; Sakurai, I; Matsumoto, F; Yamazaki, Y

    1999-10-01

    We took culture of throat swab from 77 subjects who were negative for infection of HBV, HCV, HIV and syphilis infection before and after endoscopy. Moreover, the existence of bacterium including Helicobacter pylori at overcoat of endoscopic instrument was investigated right after examination and after disinfection of endoscope. Povidoneiodine, 70% alcohol and 1% benzalkonium chloride was used as a disinfectant for endoscope, and it took less than 10 minutes to wash by hand to disinfection. alpha-haemolytic streptococci, Staphylococcus epidermids, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Candida, Pseudomonas aeruginosa and MRSA were cultured in throat swab. The rate of adhesion of bacterium especially such as Candida, K. pneumoniae and S. epidermids to endoscope was considerably high. 23 of 77 subjects had H. pylori infection, and the adhesion of H. pylori to endoscope was found to be 65.2% of the subjects. On the contrast, no bacterium was detected from the endoscopic instrument after careful disinfection. These findings stress the importance of postoperative disinfection of the endoscope to prevent the chance to acquire bacterial infection.

  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. [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

  11. 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

  12. Endoscopic anatomy of the pediatric middle ear.

    PubMed

    Isaacson, Glenn

    2014-01-01

    Traditionally, otologists have aimed to produce a clean, dry, safe ear with the best possible hearing result. More recently, "less invasively" has been added to this list of goals. The development of small-diameter, high-quality rigid endoscopes and high-definition video systems has made totally endoscopic, transcanal surgery a reality in adult otology and a possibility in pediatric otology. This article reviews the anatomy of the pediatric middle ear and its surrounding airspaces and structures based on the work of dozens of researchers over the past 50 years. It will focus on the developmental changes in ear anatomy from birth through the first decade, when structure and function change most rapidly. Understanding the limits and possibilities afforded by new endoscopic technologies, the pediatric otologist can strive for results matching or exceeding those achieved by more invasive surgical approaches.

  13. 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.

  14. [Transnasal endoscopic approaches to the cranial base].

    PubMed

    Lysoń, Tomasz; Sieśkiewicz, Andrzej; Rutkowski, Robert; Kochanowicz, Jan; Turek, Grzegorz; Rogowski, Marek; Mariak, Zenon

    2013-01-01

    Recent advances in surgical endoscopy have made it possible to reach nearly the whole cranial base through a transnasal approach. These 'expanded approaches' lead to the frontal sinuses, the cribriform plate and planum sphenoidale, the suprasellar space, the clivus, odontoid and atlas. By pointing the endoscope laterally, the surgeon can explore structures in the coronal plane such as the cavernous sinuses, the pyramid and Meckel cave, the sphenopalatine and subtemporal fossae, and even the middle fossa and the orbit. The authors of this contribution use most of these approaches in their endoscopic skull base surgery. The purpose of this contribution is to review the hitherto established endoscopic approaches to the skull base and to illustrate them with photographs obtained during self-performed procedures and/or cadaver studies. PMID:23487296

  15. 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.

  16. [Endoscopic resection of juvenile nasopharyngeal fibromas].

    PubMed

    Bernal-Sprekelsen, M; Vázquez, A A; Pueyo, J; Carbonell Casasús, J

    1998-02-01

    Current surgical approaches to juvenile nasopharyngeal angiofibromas (JNA) are exclusively external. This implies not only incisions that are mostly visible, but also a potential loss of function as well as secondary lesions and high perioperative risks. Radiotherapy aims to avoid surgery, but cannot exclude complications and possible sequelae. These consequences are commonly accepted as the "costs" for both therapies, although neither is negligible. For both surgery and radiotherapy, recurrences or persistence rates have been described, so that outcome may result in questions for the treatment used as well as the complications or sequelae. We report our experiences with two cases of JNA operated on under endoscopic control and discuss our indications for the endoscopic approach to these tumors, preoperative conditions, surgical technique, and the possible difficulties of surgery and outcome. Our results encourage us to recommend use of endoscopic surgery as a valid alternative method to approach resections of certain JNA.

  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.

  18. Design of endoscopic optical coherence tomography system

    NASA Astrophysics Data System (ADS)

    Yu, Daoyin; Li, Wanhui; Wang, Yi; Chen, Xiaodong

    2006-01-01

    Optical coherence tomography (OCT), which bases on the principle of low-coherence interferometry, is an emerging cross-sectional imaging technology. With ultrahigh resolution, OCT is sensitive enough to detect early-stage tissue abnormalities associated with diseases such as early carcinoma. To detect pathologic change in gastrointestinal tract, we combine OCT with endoscopic technique. Later we call this technique as endoscopic optical coherence tomography (EOCT). Compared with time-domain OCT imaging technique, spectral OCT eliminates depth scan in the reference arm so increases the imaging speed. Basing on spectral OCT, EOCT can realize real-time imaging. The EOCT unit is comprised of an endoscopically compatible radially scanning probe as the sample arm. In this paper the principle of spectral OCT is introduced and the crucial parameters of experimental system are discussed. Also the design of a novel probe is presented. In our experiment, a mirror is used as a sample to test the validity of this method.

  19. Endoscopic resection of a symptomatic os trigonum.

    PubMed

    Jerosch, Joerg; Fadel, Mohie

    2006-11-01

    The purpose of this study was to describe our technique and results of arthroscopic resection of a symptomatic os trigonum via two posterior portals in 10 cases. Between 1999 and 2005 we treated 10 patients with endoscopic resection of a symptomatic os trigonum. The age ranged between 19 and 32 years (average 25.9). The average follow-up was 25 months (6-61 months). Time interval between the onset of pain and endoscopic resection of the os trigonum was 20 months. Of the 10 patients, 9 were symptom free for activities of daily living (ADL) within 4 weeks after surgery. They resumed their professional sport activities in a period of 8 weeks. The average AOFAS ankle/hindfoot scale increased from 43 preoperative to 87 postoperatively. We observed no complication in these 10 patients. Endoscopic resection of the symptomatic os trigonum yields good results with minimal surgical morbidity and short recovery time.

  20. Percutaneous endoscopic decompression for lumbar spinal stenosis.

    PubMed

    Ahn, Yong

    2014-11-01

    Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.

  1. Novel endoscopic over-the-scope clip system

    PubMed Central

    Armellini, Elia; Crinò, Stefano Francesco; Orsello, Marco; Ballarè, Marco; Tari, Roberto; Saettone, Silvia; Montino, Franco; Occhipinti, Pietro

    2015-01-01

    This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy’s lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in “difficult” scenarios, like recurrent bleeding and respiratory-oesophageal fistulas. PMID:26730172

  2. Novel endoscopic over-the-scope clip system.

    PubMed

    Armellini, Elia; Crinò, Stefano Francesco; Orsello, Marco; Ballarè, Marco; Tari, Roberto; Saettone, Silvia; Montino, Franco; Occhipinti, Pietro

    2015-12-28

    This paper reports our experience with a new over-the-scope clip in the setting of recurrent bleeding and oesophageal fistula. We treated five patients with the over-the-scope Padlock Clip™. It is a nitinol ring, with six inner needles preassembled on an applicator cap, thumb press displaced by the Lock-It™ delivery system. The trigger wire is located alongside the shaft of the endoscope, and does not require the working channel. Three patients had recurrent bleeding lesions (bleeding rectal ulcer, post polypectomy delayed bleeding and duodenal Dieulafoy's lesion) and two patients had a persistent respiratory-esophageal fistula. In all patients a previous endoscopic attempt with standard techniques had been useless. All procedures were conducted under conscious sedation but for one patient that required general anaesthesia due to multiple comorbidities. We used one Padlock Clip™ for each patient in a single session. Simple suction was enough in all of our patients to obtain tissue adhesion to the instrument tip. A remarkably short application time was recorded for all cases (mean duration of the procedure: 8 min). We obtained technical and immediate clinical success for every patient. No major immediate, early or late (within 24 h, 7 d or 4 wk) adverse events were observed, over follow-up durations lasting a mean of 109.4 d. One patient, treated for duodenal bulb bleeding from a Dieulafoy's lesion, developed signs of mild pancreatitis 24 h after the procedure. The new over-the-scope Padlock Clip™ seems to be simple to use and effective in different clinical settings, particularly in "difficult" scenarios, like recurrent bleeding and respiratory-oesophageal fistulas.

  3. Fast track endoscopic thoracic sympathicotomy.

    PubMed

    Duarte, João Bosco Vieira; Kux, Peter; Castro, Carlos H V; Cruvinel, Marcos G C; Costa, José R R

    2003-12-01

    The length of hospital stay is an important factor of cost and psychological discomfort in the treatment of hyperhidrosis by endoscopic thoracic sympathicotomy (ETS). Our experience enrolls 1587 patients operated on an outpatient basis in the last 10 years and seven months. This study aimed to confirm that ETS can be performed on an outpatient basis. Fifty-two consecutive patients (30 males and 22 females) were submitted to ETS under general anesthesia using a single lumen endotracheal tube, with lung collapse by intrapleural injection of CO(2). The sympathetic chain and the communicating rami were severed at different levels according to hyperhidrosis location. Patients were physical state American Society of Anesthesiologists 1 and 2. Age varied between 13 and 55 years (27.3 +/- 10.2 years). They were monitored with ECG, SPO2, NIBP, expired CO(2), sevoflurane analyzer, and airway pressure. Normal saline (40.0 +/- 2.7 ml/kg) was infused intravenously. The drugs used were propofol, alfentanil, rocuronium, ondansetron, dexamethasone, dipyrone, cetoprofene and sevoflurane. Anesthesia and post-operative data were analyzed. Post-operative thoracic X-rays were taken in 20 patients before discharge. Anesthesia lasted 67.2 +/- 20.8 minutes, and the surgical procedure took 46.3 +/- 20.9 minutes. The patients stayed 18.0 +/- 11.0 minutes in the post-anaesthetic care unit and were discharged from hospital after 150.3 +/- 43.1 minutes. The only abnormal post-operative event observed was insignificant residual carbothorax, found in 2 (10%) of the thoracic X-rays taken. In conclusion, this study confirmed that ETS can be performed safely on an outpatient basis. PMID:14673677

  4. 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

  5. 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.

  6. 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

  7. Endoscopic laser treatment for pediatric nasal allergy.

    PubMed

    Araki, S; Suzuki, N; Sato, H; Yamaguchi, T; Fujita, H; Umezawa, Y; Suzuki, M

    2000-01-01

    We have used the carbon dioxide (CO(2)) laser and the gallium aluminium arsenide (GaAlAs) diode laser with flexible fiber delivery instruments for vaporization of the inferior nasal turbinate in pediatric patients since 1993. Under endoscopic control, the whole inferior turbinate was vaporized by 5-10 W laser output delivered via an optical fiber. Generally, the nasal mucosa changes into normal mucosa, and symptoms improve. The greatest symptomatic improvement was in nasal obstruction. The results obtained by the two laser devices were similar although they have had different characteristics. Endoscopic laser surgery is effective in the treatment of pediatric nasal allergy.

  8. 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

  9. 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

  10. Recent Update of Gastrointestinal Endoscope Reprocessing

    PubMed Central

    Hong, Kyong Hee

    2013-01-01

    As infection-related issues have become one of the most important concerns in endoscopy centers, proper reprocessing of endoscopes has attracted great interest. Compliance with established guidelines for reprocessing is critical to prevent pathogen transmission. However, hospital compliance with guidelines has not been satisfactory. To increase compliance, efforts have focused on developing new and more innovative disinfectants and an automated endoscope reprocessor. Reprocessing must be performed by appropriately trained personnel and regular monitoring of reprocessing is essential for quality assurance to improve compliance. PMID:23767038

  11. Endoscopic management of acute peptic ulcer bleeding.

    PubMed

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

    2014-12-01

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

  12. Duodenal angiolipoma -- endoscopic diagnosis and therapy.

    PubMed

    Mohl, W; Fischinger, J; Moser, C; Remberger, K; Zeuzem, S; Stallmach, A

    2004-12-01

    We report on two patients with upper gastrointestinal bleeding owing to duodenal angiolipomas, and their endoscopic diagnosis and therapy. In both cases the bleeding source was a pedunculated tumour. Diagnosis and definitive therapy was made by endoscopic snare polypectomy. After stopping the bleeding from the mucosal defect by injection therapy in one patient, the further course was uneventful in both. A colonic angiolipoma in one of the patients was also treated by polypectomy. Gastrointestinal angiolipomas are exceedingly rare, however, these case reports show that duodenal angiolipomas do exist and that they, as lipomas, may lead to substantial gastrointestinal bleeding and may be treated successfully by standard polypectomy techniques.

  13. Revision endoscopic ethmoidectomy for chronic rhinosinusitis.

    PubMed

    Corey, J P; Bumsted, R M

    1989-08-01

    In summary, revision endoscopic surgery for chronic rhinosinusitis can be performed safely by using the middle turbinate (or portion thereof) or the anterior wall of the sphenoid as a landmark. These cases are more difficult and may be more prone to bleeding and scarring. The surgeon should be thoroughly familiar with and not hesitate to switch to conventional techniques in the event of excessive bleeding, proptosis, or a loss of landmarks. Aggressive postoperative care and follow-up, including office endoscopic "touch-up" procedures, may be necessary to maintain control of aggressive disease, along with continued medical management and any indicated immunotherapy.

  14. 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

  15. [Radiation and endoscopic diagnosis of pneumonia].

    PubMed

    Fedchenko, G G; Chernekhovskaia, N E; Rannev, I B

    2002-01-01

    The authors analyze the results of different types of radiation and endoscopic studies of 151 patients with pneumonia with an established etiological agent. There is a correlation of X-ray semiotics and endoscopic changes with the clinical manifestation and causative agent of the disease. When the studies are combined, emphasis is laid on the role of endoscopy in verifying the diagnosis, in specifying an etiological agent, and in implementing therapeutical measures to prevent complications. An algorithm of radiation imaging techniques is proposed to examine patients with pneumonia and of their purpose-oriented use according to the task set.

  16. Endoscopically Assisted Anterior Subcutaneous Transposition of Ulnar Nerve.

    PubMed

    Lui, Tun Hing

    2016-06-01

    Ulnar nerve compression at the elbow is the most common neuropathy of the upper extremity. Surgical options include in situ decompression, decompression with anterior transposition of the ulnar nerve, and medial epicondylectomy with or without decompression. With the advancement of endoscopic surgery, techniques of endoscopic in situ decompression of the ulnar nerve and endoscopic anterior transposition of ulnar nerve have been reported. This article describes a technique of endoscopically assisted anterior subcutaneous transposition of ulnar nerve that is composed of an open release and mobilization of the ulnar nerve at and distal to the cubital tunnel and endoscopic release and mobilization of the ulnar nerve proximal to the cubital tunnel. PMID:27656391

  17. Speech and Language Delay

    MedlinePlus

    MENU Return to Web version Speech and Language Delay Overview How do I know if my child has speech delay? Every child develops at his or her ... of the same age, the problem may be speech delay. Your doctor may think your child has ...

  18. Delay Discounting and Gambling

    PubMed Central

    Madden, Gregory J.; Francisco, Monica T.; Brewer, Adam T.; Stein, Jeffrey S.

    2011-01-01

    Delay discounting describes the decline in the value of a reinforcer as the delay to that reinforcer increases. A review of the available studies revealed that steep delay discounting is positively correlated with problem or pathological gambling. One hypothesis regarding this correlation derives from the discounting equation proposed by Mazur (1989). According to the equation, steeper discounting renders the difference between fixed-delayed rewards and gambling-like variable-delayed rewards larger; with the latter being more valuable. The present study was designed to test this prediction by first assessing rats’ impulsive choices across four delays to a larger-later reinforcer. A second condition quantified strength of preference for mixed- over fixed-delays, with the duration of the latter adjusted between sessions to achieve indifference. Strength of preference for the mixed-delay alternative is given by the fixed delay at indifference (lower fixed-delay values reflect stronger preferences). Percent impulsive choice was not correlated with the value of the fixed delay at indifference and, therefore, the prediction of the hyperbolic model of gambling was not supported. A follow-up assessment revealed a significant decrease in impulsive choice after the second condition. This shift in impulsive choice could underlie the failure to observe the predicted correlation between impulsive choice and degree of preference for mixed- over fixed delays. PMID:21352902

  19. Endoscopic Resection for Small Rectal Neuroendocrine Tumors: Comparison of Endoscopic Submucosal Resection with Band Ligation and Endoscopic Submucosal Dissection.

    PubMed

    Bang, Byoung Wook; Park, Jin Seok; Kim, Hyung Kil; Shin, Yong Woon; Kwon, Kye Sook; Kim, Joon Mee

    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

  20. 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

  1. 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

  2. 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

  3. [Endoscopic-radiologic diagnosis and therapy of the bile ducts. Results of endoscopic papillotomy].

    PubMed

    Reisinger, W; Münster, B; Schulz, H J; Otto, R; Seifert, C

    1989-01-01

    Endoscopic-radiologic methods for demonstrating the hepatobiliary and pancreatic ducts are an integrated part of the diagnostic spectrum of gastroenterologic centers. At the Charité since 1975 we have made more than 5,500 endoscopic-retrograde cholangio-pancreaticographies (ERCP's). This method provides immediately or later an adequate therapy as an alternative to the otherwise necessary surgery. The most frequently used and basic method is endoscopic papillotomy (EPT). In most cases it precedes endoscopic removal of concrements, prosthetic drainage of biliary pathways or extracorporal shockwave lithotripsy (ESWL). Since 1977 we have carried out 2,050 EPT's at the Charité, more than 60% of these for patients of higher age (above 60). With 98.3% successful interventions complications were seen in only 4.7% of the cases. The influence of close interdisciplinary cooperation of endoscopicists and radiologists on the results of the investigation and the rate of complications is discussed.

  4. 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

  5. Endoscopic submucosal dissection combined with endoscopic injection sclerotherapy for early gastric cancer on gastric fundal varices.

    PubMed

    Uno, Kaname; Iijima, Katsunori; Koike, Tomoyuki; Abe, Yasuhiko; Asano, Naoki; Yokosawa, Satoshi; Imatani, Akira; Shimosegawa, Tooru

    2012-08-01

    Currently, there is little report of treatment strategy for early gastric cancer (EGC) on gastric fundal varices (GFVs), because controlling GFVs was more challenging than controlling gastric cardiac varices associated with esophageal varices. We first report effective endoscopic treatment of EGC on GFVs of a 77-year-old man with Child-B cirrhosis. Endoscopic ultrasound and multidetector-row computed tomography studies revealed intramucosal EGC on variceal components, supplied from posterior gastric vein and drained to subphrenic vein without gastrorenal shunt. With informed consent, we performed endoscopic submucosal dissection (ESD) after eradication of GFVs by endoscopic injection sclerotherapy (EIS). Histologic assessment revealed curability of ESD and inflammation and fibrosis around EIS site. Thereafter, no recurrence and complication had occurred. To avoid life-threatening bleeding from GFVs, we achieved complete resection by ESD under direct visualization of submucosa after eradication of GFVs by EIS based on the examination of hemodynamics and local relationship between EGC and GFVs.

  6. Pancreas imaging by computed tomography after endoscopic retrograde pancreatography. [Dogs; patients

    SciTech Connect

    Frick, M.P.; O'Leary, J.F.; Salomonowitz, E.; Stoltenberg, E.; Hutton, S.; Gedgaudas, E.

    1984-01-01

    A method using CT after endoscopic retrograde pancreatography (CT-ERP) is described for pancreatic imaging. When using an ERP technique in the canine model comparable to that used in humans, small amounts of contrast material in peripheral pancreatic radicles resulted in enhancement of the pancreas on CT scans. Nine patients were also studied by CT-ERP images. The main pancreatic duct was seen on delayed images. In cases of chronic pancreatitis (n = 2), pancreatic opacification was patchy and heterogeneous. There was no contrast-material enhancement in areas of pancreatic carcimomas (n = 2). CT-ERP showed the true extent of carcinoma better than ERP alone.

  7. Sinus barotrauma--late diagnosis and treatment with computer-aided endoscopic surgery.

    PubMed

    Larsen, Anders Schermacher; Buchwald, Christian; Vesterhauge, Søren

    2003-02-01

    Sinus barotrauma is usually easy to diagnose, and treatment achieves good results. We present two severe cases where delayed diagnosis caused significant morbidity. The signs and symptoms were atypical and neither the patients themselves, nor the initial examiners recognized that the onset of symptoms coincided with descent in a commercial airliner. CT and MRI scans of the brain were normal, but in both cases showed opafication of the sphenoid sinuses, which lead to the correct diagnosis. Subsequent surgical intervention consisting of endoscopic computer-aided surgery showed blood and petechia in the affected sinuses. This procedure provided immediate relief.

  8. Natural Orifice Transluminal Endoscopic Surgery and Upper Gastrointestinal Tract

    PubMed Central

    2013-01-01

    Since the first transgastric natural orifice transluminal endoscopic surgery was described, various applications and modified procedures have been investigated. Transgastric natural orifice transluminal endoscopic surgery for periotoneoscopy, cholecystectomy, and appendectomy all seem viable in humans, but additional studies are required to demonstrate their benefits and roles in clinical practice. The submucosal tunneling method enhances the safety of peritoneal access and gastric closure and minimizes the risk of intraperitoneal leakage of gastric air and juice. Submucosal tunneling involves submucosal tumor resection and peroral endoscopic myotomy. Peroral endoscopic myotomy is a safe and effective treatment option for achalasia, and the most promising natural orifice transluminal endoscopic surgery procedure. Endoscopic full-thickness resection is a rapidly developing natural orifice transluminal endoscopic surgery procedure for the upper gastrointestinal tract and can be performed with a hybrid natural orifice transluminal endoscopic surgery technique (combining a laparoscopic approach) to overcome some limitations of pure natural orifice transluminal endoscopic surgery. Studies to identify the most appropriate role of endoscopic full-thickness resection are anticipated. In this article, I review the procedures of natural orifice transluminal endoscopic surgery associated with the upper gastrointestinal tract. PMID:24511415

  9. Technology for Psychomotor Skills Testing in Endoscopic Surgery.

    PubMed

    Hanna; Drew; Cuschieri

    1997-06-01

    Psychomotor research is essential for aptitude-based selection of surgical trainees and sound surgical practice. Two microprocessor-controlled psychomotor testers were developed to evaluate psychomotor skills related to endoscopic surgery. Dundee Endoscopic Psychomotor Tester (DEPT) measures single-handed performance in an endoscopic environment and therefore it can be used to evaluate differing abilities between the right and left hand. Advanced Dundee endoscopic Psychomotor Tester (ADEPT) measures two-handed performance, and consequently it can be used to assess coordinated bimanual endoscopic manipulations. Psychomotor testers provide real-time objective scoring systems that have several aspects of face validity to real endoscopic environment. Studies on medical students have confirmed that objective evaluation of task performance in an endoscopic field is feasible and have documented differences in psychomotor abilities between subjects.

  10. Infectious diseases linked to cross-contamination of flexible endoscopes

    PubMed Central

    Kenters, Nikki; Huijskens, Elisabeth G. W.; Meier, Corianne; Voss, Andreas

    2015-01-01

    Flexible endoscopes are widely used to examine, diagnose, and treat medical disorders. While the risk of endoscopy-related transmission of infection is estimated to be very low, more health care-associated infections are related to contaminated endoscopes than to any other medical device. Flexible endoscopes can get highly contaminated with microorganisms, secretions and blood during use. The narrow lumens and multiple internal channels make the cleaning of flexible endoscopes a complex and difficult task. Despite the availability of international, national and local endoscope reprocessing guidelines, contamination and transmission of microorganisms continue to occur. These transmissions are mostly related to the use of defective equipment, endoscope reprocessing failures, and noncompliance with recommended guidelines. This article presents an overview of publications about case reports and outbreaks related to contamination of flexible endoscopes. PMID:26355428

  11. Correlation between Histopathological and Endoscopic Findings of Stomach Growth.

    PubMed

    Mahmuda, S; Bashar, M F; Yesmin, N; Khatun, M A

    2016-01-01

    This study was carried out in the Department of Pathology of Islami Bank Hospital, Barisal to correlate between histopathological and endoscopic diagnosis of suspected malignant gastric lesions. A total of sixty six endoscopic biopsies were studied retrospectively, during the period from February 2011 to January 2014. The biopsies were retrieved using video-endoscope. These were transferred to a bottle containing 10% neutral formalin, processed and stained routinely with Haematoxylin and Eosin. Out of 66(100%) gastric endoscopic biopsies, 29(44%) were malignant. The correlation of endoscopic and histopathological diagnosis of these gastric lesions was 44%. Endoscopic examination and biopsy is a convenient procedure for accurate objective assessment of patients with symptoms of gastrointestinal tract. Endoscopy is incomplete without biopsy and histopathology is the gold standard for the diagnosis of endoscopically detected lesions.

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

    PubMed

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

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver. PMID:27380571

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

    PubMed

    Park, Seon Mee

    2016-07-01

    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

  14. 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

  15. Analysis of the color rendition of flexible endoscopes

    NASA Astrophysics Data System (ADS)

    Murphy, Edward M.; Hegarty, Francis J.; McMahon, Barry P.; Boyle, Gerard

    2003-03-01

    Endoscopes are imaging devices routinely used for the diagnosis of disease within the human digestive tract. Light is transmitted into the body cavity via incoherent fibreoptic bundles and is controlled by a light feedback system. Fibreoptic endoscopes use coherent fibreoptic bundles to provide the clinician with an image. It is also possible to couple fibreoptic endoscopes to a clip-on video camera. Video endoscopes consist of a small CCD camera, which is inserted into gastrointestinal tract, and associated image processor to convert the signal to analogue RGB video signals. Images from both types of endoscope are displayed on standard video monitors. Diagnosis is dependent upon being able to determine changes in the structure and colour of tissues and biological fluids, and therefore is dependent upon the ability of the endoscope to reproduce the colour of these tissues and fluids with fidelity. This study investigates the colour reproduction of flexible optical and video endoscopes. Fibreoptic and video endoscopes alter image colour characteristics in different ways. The colour rendition of fibreoptic endoscopes was assessed by coupling them to a video camera and applying video colorimetric techniques. These techniques were then used on video endoscopes to assess how the colour rendition of video endoscopes compared with that of optical endoscopes. In both cases results were obtained at fixed illumination settings. Video endoscopes were then assessed with varying levels of illumination. Initial results show that at constant luminance endoscopy systems introduce non-linear shifts in colour. Techniques for examining how this colour shift varies with illumination intensity were developed and both methodology and results will be presented. We conclude that more rigorous quality assurance is required to reduce colour error and are developing calibration procedures applicable to medical endoscopes.

  16. Direct Endoscopic Necrosectomy Versus Step-Up Approach for Walled-Off Pancreatic Necrosis

    PubMed Central

    Kumar, Nitin; Conwell, Darwin L.; Thompson, Christopher C.

    2016-01-01

    Objectives Infected walled-off pancreatic necrosis (WOPN) is a complication of acute pancreatitis requiring intervention. Surgery is associated with considerable morbidity. Percutaneous catheter drainage (PCD), initial therapy in the step-up approach, minimizes complications. Direct endoscopic necrosectomy (DEN) has demonstrated safety and efficacy. We compared outcome and health care utilization of DEN versus step-up approach. Methods This was a matched cohort study using a prospective registry. Twelve consecutive DEN patients were matched with 12 step-up approach patients. Outcomes were clinical resolution after primary therapeutic modality, new organ failure, mortality, endocrine or exocrine insufficiency, length of stay, and health care utilization. Results Clinical resolution in 11 of 12 patients after DEN versus 3 of 12 step-up approach patients after PCD (P < 0.01). Nine step-up approach patients required surgery; 7 of these experienced complications. Direct endoscopic necrosectomy resulted in less new antibiotic use, pulmonary failure, endocrine insufficiency, and shorter length of stay (P < 0.05). Health care utilization was lower after DEN by 5.2:1 (P < 0.01). Conclusions Direct endoscopic necrosectomy may be superior to step-up approach for WOPN with suspected or established infection. Primary PCD generally delayed definitive therapy. Given the higher efficacy, shorter length of stay, and lower health care utilization, DEN could be the first-line therapy for WOPN, with primary PCD for inaccessible or immature collections. PMID:25083997

  17. Endoscopic endonasal cavernous sinus surgery, with special reference to pituitary adenomas.

    PubMed

    Frank, Giorgio; Pasquini, Ernesto

    2006-01-01

    Cavernous sinus surgery has always been a surgical challenge because of the high functional importance of this region and the associated high morbidity. The augmented peripheral vision of the endoscope has led to the development of surgical approaches that allow adequate exposure of the cavernous sinus, with a reduction in surgical morbidity. Since 1998, 65 patients with pituitary adenomas and intraoperative evidence of cavernous sinus invasion were treated with a purely endoscopic approach. Follow-up was of at least 6 (mean 51.2) months. There was no perioperative mortality and extremely low morbidity. Radical tumor removal was obtained in 21/35 cases with nonfunctioning adenomas. Hormonal remission was obtained in 13/30 functioning adenomas. One patient with partial hypopituitarism and 1 patient with persistent diabetes insipidus were seen. Three patients with delayed CSF leaks required endoscopic repair. In 1 patient with hemorrhagic infarction in a residual tumor, reintervention with craniotomy was necessary. We advocate the central role of surgery in the treatment of cavernous sinus tumors, since it allows definition of true cavernous sinus involvement, histopathological diagnosis and, when cure is not feasible, tumor volume reduction, which might be an important factor in the response to adjuvant therapy. PMID:16474216

  18. Rare gastrointestinal lymphomas: The endoscopic investigation

    PubMed Central

    Vetro, Calogero; Bonanno, Giacomo; Giulietti, Giorgio; Romano, Alessandra; Conticello, Concetta; Chiarenza, Annalisa; Spina, Paolo; Coppolino, Francesco; Cunsolo, Rosario; Raimondo, Francesco Di

    2015-01-01

    Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease. PMID:26265987

  19. High-resolution imaging using endoscopic holography

    NASA Astrophysics Data System (ADS)

    Bjelkhagen, Hans I.

    1990-08-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help to their control. 1.

  20. Holographic high-resolution endoscopic image recording

    NASA Astrophysics Data System (ADS)

    Bjelkhagen, Hans I.

    1991-03-01

    Endoscopic holography or endoholography combines the features of endoscopy and holography. The purpose of endoholographic imaging is to provide the physician with a unique means of extending diagnosis by providing a life-like record of tissue. Endoholographic recording will provide means for microscopic examination of tissue and in some cases may obviate the need to excise specimens for biopsy. In this method holograms which have the unique properties of three-dimensionality large focal depth and high resolution are made with a newly designed endoscope. The endoscope uses a single-mode optical fiber for illumination and single-beam reflection holograms are recorded in close contact with the tissue at the distal end of the endoscope. The holograms are viewed under a microscope. By using the proper combinations of dyes for staining specific tissue types with various wavelengths of laser illumination increased contrast on the cellular level can be obtained. Using dyes such as rose bengal in combination with the 514. 5 nm line of an argon ion laser and trypan blue or methylene blue with the 647. 1 nm line of a krypton ion laser holograms of the stained colon of a dog showed the architecture of the colon''s columnar epithelial cells. It is hoped through chronological study using this method in-vivo an increased understanding of the etiology and pathology of diseases such as Crohn''s diseases colitis proctitis and several different forms of cancer will help

  1. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  2. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  3. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  4. Dual-channel spectrally encoded endoscopic probe

    PubMed Central

    Engel, Guy; Genish, Hadar; Rosenbluh, Michael; Yelin, Dvir

    2012-01-01

    High quality imaging through sub-millimeter endoscopic probes provides clinicians with valuable diagnostics capabilities in hard to reach locations within the body. Spectrally encoded endoscopy (SEE) has been shown promising for such task; however, challenging probe fabrication and high speckle noise had prevented its testing in in vivo studies. Here we demonstrate a novel miniature SEE probe which incorporates some of the recent progress in spectrally encoded technology into a compact and robust endoscopic system. A high-quality miniature diffraction grating was fabricated using automated femtosecond laser cutting from a large bulk grating. Using one spectrally encoded channel for imaging and a separate channel for incoherent illumination, the new system has large depth of field, negligible back reflections and well controlled speckle noise which depends on the core diameter of the illumination fiber. Moreover, by using a larger imaging channel, higher groove density grating, shorter wavelength and broader spectrum, the new endoscopic system now allow significant improvements in almost all imaging parameter compared to previous systems, through an ultra-miniature endoscopic probe. PMID:22876349

  5. The endoscopic diagnosis of early gastric cancer

    PubMed Central

    Yao, Kenshi

    2013-01-01

    The aim of this article is to demonstrate the basic principles for the endoscopic diagnosis of early gastric cancer. The diagnostic process can be divided into two steps, detection and characterization. Detection requires good endoscopic technique, and thorough knowledge. With regard to technique, we should administer the optimum preparation to patients, including an antiperistaltic agent. Furthermore, in order to map the entire stomach we need to follow a standardized protocol, and we propose a systematic screening protocol for the stomach. With regard to knowledge, we should be able to identify high-risk background mucosa, and we should be aware of the indicators of a suspicious lesion. Chromoendoscopy and magnifying endoscopy are promising image-enhanced endoscopic techniques for characterization. The proposed criteria for a cancerous lesion are as follows: conventional endoscopic findings of 1) a well-demarcated lesion and 2) irregularity in color/surface pattern; vessel plus surface classification using magnifying endoscopy with narrow-band imaging findings of 1) irregular microvascular pattern with a demarcation line or 2) irregular microsurface pattern with a demarcation line. Conventional endoscopy and subsequent image-enhanced endoscopy can both contribute to the detection of early gastric cancer. PMID:24714327

  6. Endoscopic assisted cochlear implants in ear malformations.

    PubMed

    Marchioni, Daniele; Soloperto, Davide; Guarnaccia, Maria C; Genovese, Elisabetta; Alicandri-Ciufelli, Matteo; Presutti, Livio

    2015-10-01

    The aim of present study is to describe the use of the endoscopic assisted cochlear implant approach in cases with severely malformed temporal bones and with anomalous anatomy of the inner ear and tympanic cavity. Eight patients with malformed middle and inner ear and bilateral profound hearing loss were operated using an endoscopic assisted cochlear implant procedure at our tertiary university referral center between January and September 2013. Five patients received a cochlear implant using a suprameatal endoscopic assisted approach. A chart review of clinical data and videos from the operations was performed. All procedures were re-analyzed and codified. In all patients, discharge from hospital was on the third day post-surgery. No immediate or late postoperative complications were noted. The current mean follow-up is 6 months, with range between 4 and 12 months. This approach proved to be successful in cochlear implant placement. It guaranteed a very good control on the facial nerve, even in cases with difficult anatomical conditions, mainly thanks to the endoscopic procedure. It also permitted an appropriate anatomical orientation of the abnormal middle ear with a direct safe cochleostomy, when the round window position would have been difficult to treat using a traditional approach. PMID:25085636

  7. Endoscopic approaches to enteral nutritional support.

    PubMed

    DiSario, James A

    2006-01-01

    Enteral is preferred to parenteral nutritional support for acute and chronic diseases because it is more physiological and associated with fewer infection complications. Nasal tube feedings are generally used for 30 days or less and percutaneous access for the longer-term. Feeding by naso-gastric tubes is appropriate for most critically ill patients. However, trans-pyloric feeding is indicated for those with regurgitation and aspiration of gastric feeds. Deep naso-jejunal tube feeding is appropriate for patients with severe acute pancreatitis. There are several methods for endoscopic placement of naso-enteric tubes. Percutaneous endoscopic gastrostomy is used for most persons requiring long-term support. Long-term jejunal feeding is most often used for persons with chronic aspiration of gastric feeds, chronic pancreatitis intolerant to eating, or persons in need of concomitant gastric decompression. Percutaneous endoscopic gastrostomy with a jejunal tube extension is fraught with tube dysfunction and dislocation. Direct percutaneous endoscopic jejunostomy tubes may be more robust, but are less commonly performed.

  8. Update on the endoscopic treatments for achalasia

    PubMed Central

    Uppal, Dushant S; Wang, Andrew Y

    2016-01-01

    Achalasia is the most common primary motility disorder of the esophagus and presents as dysphagia to solids and liquids. It is characterized by impaired deglutitive relaxation of the lower esophageal sphincter. High-resolution manometry allows for definitive diagnosis and classification of achalasia, with type II being the most responsive to therapy. Since no cure for achalasia exists, early diagnosis and treatment of the disease is critical to prevent end-stage disease. The central tenant of diagnosis is to first rule out mechanical obstruction due to stricture or malignancy, which is often accomplished by endoscopic and fluoroscopic examination. Therapeutic options include pneumatic dilation (PD), surgical myotomy, and endoscopic injection of botulinum toxin injection. Heller myotomy and PD are more efficacious than pharmacologic therapies and should be considered first-line treatment options. Per oral endoscopic myotomy (POEM) is a minimally-invasive endoscopic therapy that might be as effective as surgical myotomy when performed by a trained and experienced endoscopist, although long-term data are lacking. Overall, therapy should be individualized to each patient’s clinical situation and based upon his or her risk tolerance, operative candidacy, and life expectancy. In instances of therapeutic failure or symptom recurrence re-treatment is possible and can include PD or POEM of the wall opposite the site of prior myotomy. Patients undergoing therapy for achalasia require counseling, as the goal of therapy is to improve swallowing and prevent late manifestations of the disease rather than to restore normal swallowing, which is unfortunately impossible.

  9. Visual SLAM for Handheld Monocular Endoscope.

    PubMed

    Grasa, Óscar G; Bernal, Ernesto; Casado, Santiago; Gil, Ismael; Montiel, J M M

    2014-01-01

    Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences.

  10. Visual SLAM for Handheld Monocular Endoscope.

    PubMed

    Grasa, Óscar G; Bernal, Ernesto; Casado, Santiago; Gil, Ismael; Montiel, J M M

    2014-01-01

    Simultaneous localization and mapping (SLAM) methods provide real-time estimation of 3-D models from the sole input of a handheld camera, routinely in mobile robotics scenarios. Medical endoscopic sequences mimic a robotic scenario in which a handheld camera (monocular endoscope) moves along an unknown trajectory while observing an unknown cavity. However, the feasibility and accuracy of SLAM methods have not been extensively validated with human in vivo image sequences. In this work, we propose a monocular visual SLAM algorithm tailored to deal with medical image sequences in order to provide an up-to-scale 3-D map of the observed cavity and the endoscope trajectory at frame rate. The algorithm is validated over synthetic data and human in vivo sequences corresponding to 15 laparoscopic hernioplasties where accurate ground-truth distances are available. It can be concluded that the proposed procedure is: 1) noninvasive, because only a standard monocular endoscope and a surgical tool are used; 2) convenient, because only a hand-controlled exploratory motion is needed; 3) fast, because the algorithm provides the 3-D map and the trajectory in real time; 4) accurate, because it has been validated with respect to ground-truth; and 5) robust to inter-patient variability, because it has performed successfully over the validation sequences. PMID:24107925

  11. [ENDOSCOPIC LUNG VOLUME REDUCTION IN PULMONARY EMPHYSEMA].

    PubMed

    Duysinx, B; Heinen, V; Louis, R; Corhay, J-L

    2015-12-01

    Emphysema is characterized by an irreversible alveolar destruction, a progressive lung hyperinflation and a dysfunction of respiratory muscles. It induces a respiratory functional limitation and a decrease of quality of life. Endoscopic lung volume reduction represents a potential alternative to surgical treatments for advanced heterogeneous emphysema without concomitant surgical morbidity. The different bronchoscopic systems for lung volume reduction currently under evaluation are presented.

  12. Endoscopic management of chronic radiation proctitis

    PubMed Central

    Rustagi, Tarun; Mashimo, Hiroshi

    2011-01-01

    Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis. PMID:22147960

  13. Endoscopic management of chronic radiation proctitis.

    PubMed

    Rustagi, Tarun; Mashimo, Hiroshi

    2011-11-01

    Chronic radiation proctopathy occurs in 5%-20% of patients following pelvic radiotherapy. Although many cases resolve spontaneously, some lead to chronic symptoms including diarrhea, tenesmus, urgency and persistent rectal bleeding with iron deficiency anemia requiring blood transfusions. Treatments for chronic radiation proctitis remain unsatisfactory and the basis of evidence for various therapies is generally insufficient. There are very few controlled or prospective trials, and comparisons between therapies are limited because of different evaluation methods. Medical treatments, including formalin, topical sucralfate, 5-amino salicylic acid enemas, and short chain fatty acids have been used with limited success. Surgical management is associated with high morbidity and mortality. Endoscopic therapy using modalities such as the heater probe, neodymium:yttrium-aluminium-garnet laser, potassium titanyl phosphate laser and bipolar electrocoagulation has been reported to be of some benefit, but with frequent complications. Argon plasma coagulation is touted to be the preferred endoscopic therapy due to its efficacy and safety profile. Newer methods of endoscopic ablation such as radiofrequency ablation and cryotherapy have been recently described which may afford broader areas of treatment per application, with lower rate of complications. This review will focus on endoscopic ablation therapies, including such newer modalities, for chronic radiation proctitis.

  14. Transanal Endoscopic Microsurgery: Current and Future Perspectives.

    PubMed

    Gilshtein, Hayim; Duek, Simon-Daniel; Khoury, Wisam

    2016-06-01

    Transanal endoscopic microsurgery is part of the colorectal surgeons' armamentarium for over 2 decades. Since its first implementation for the resection of benign and T1 malignant lesions in the rectum several new indications were developed and it carries additional promise for further extension in upcoming years. Herein we review the technique, its current indications, novel implications, and future perspectives.

  15. An endoscopic wireless gastrostimulator (with video)

    PubMed Central

    Deb, Sanchali; Tang, Shou-Jiang; Abell, Thomas L.; Rao, Smitha; Huang, Wen-Ding; To, S.D. Filip; Lahr, Christopher; Chiao, Jung-Chih.

    2016-01-01

    Background Gastric electric stimulation (GES) at a high-frequency, low-energy setting is an option for treating refractory gastroparesis. The currently available commercial stimulator, the Enterra neurostimulator (Medtronic Inc, Minneapolis, MN), however, requires surgical implantation and is powered by a nonrechargeable battery. Objective To develop and test a miniature wireless GES device for endoscopic implantation in an experimental model. Design In-vivo gastric signals were recorded and measured in a nonsurvival swine model (n = 2; 110-lb animals). Intervention An endoscopically placed, wireless GES device was inserted into the stomach through an overtube; the two GES electrodes were endoscopically attached to the gastric mucosa and secured with endoclips to permit stimulation. Main Outcome Measurements Stable electrogastrogram measures were observed during GES stimulation. Results Electrogastrogram recordings demonstrated that gastric slow waves became more regular and of constant amplitudes when stomach tissues were stimulated, in comparison with no stimulation. The frequency-to-amplitude ratio also changed significantly with stimulation. Limitation Nonsurvival pig studies. Conclusion Gastric electric stimulation is feasible by our endoscopically implanted, wireless GES device. PMID:22248609

  16. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  17. 21 CFR 882.1480 - Neurological endoscope.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Neurological endoscope. 882.1480 Section 882.1480 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... ventricles of the brain. (b) Classification. Class II (performance standards)....

  18. Peroral Endoscopic Myotomy: Establishing a New Program

    PubMed Central

    Kumta, Nikhil A.; Mehta, Shivani; Kedia, Prashant; Weaver, Kristen; Sharaiha, Reem Z.; Fukami, Norio; Minami, Hitomi; Casas, Fernando; Gaidhane, Monica; Lambroza, Arnon

    2014-01-01

    Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure. PMID:25324996

  19. Peroral endoscopic myotomy: establishing a new program.

    PubMed

    Kumta, Nikhil A; Mehta, Shivani; Kedia, Prashant; Weaver, Kristen; Sharaiha, Reem Z; Fukami, Norio; Minami, Hitomi; Casas, Fernando; Gaidhane, Monica; Lambroza, Arnon; Kahaleh, Michel

    2014-09-01

    Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.

  20. Endoscope-Assisted Microneurosurgery for Intracranial Aneurysms

    PubMed Central

    Galzio, Renato J.; Di Cola, Francesco; Raysi Dehcordi, Soheila; Ricci, Alessandro; De Paulis, Danilo

    2013-01-01

    Background: The endovascular techniques has widely changed the treatment of intracranial aneurysms. However surgery still represent the best therapeutic option in case of broad-based and complex lesions. The combined use of endoscopic and microsurgical techniques (EAM) may improve surgical results. Objective: The purpose of our study is to evaluate the advantages and limits of EAM for intracranial aneurysms. Methods: Between January 2002 and December 2012, 173 patients, harboring 206 aneurysms were surgically treated in our department with the EAM technique. One hundred and fifty-seven aneurysms were located in the anterior circulation and 49 were in the posterior circulation. Standard tailored approaches, based on skull base surgery principles, were chosen. The use of the endoscope included three steps: initial inspection, true operative time, and final inspection. For each procedure, an intraoperative video and an evaluation schedule were prepared, to report surgeons’ opinions about the technique itself. In the first cases, we always used the endoscope during surgical procedures in order to get an adequate surgical training. Afterwards we became aware in selecting cases in which to apply the endoscopy, as we started to become familiar with its advantages and limits. Results: After clipping, all patients were undergone postoperative cerebral angiography. No surgical mortality related to EAM were observed. Complications directly related to endoscopic procedures were rare. Conclusion: Our retrospective study suggests that endoscopic efficacy for aneurysms is only scarcely influenced by the preoperative clinical condition (Hunt–Hess grade), surgical timing, presence of blood in the cisterns (Fisher grade) and/or hydrocephalus. However the most important factors contributing to the efficacy of EAM are determined by the anatomical locations and sizes of the lesions. Furthermore, the advantages are especially evident using dedicated scopes and holders, after an

  1. High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience

    PubMed Central

    Pioche, Mathieu; Lépilliez, Vincent; Déprez, Pierre; Giovannini, Marc; Caillol, Fabrice; Piessevaux, Hubert; Rivory, Jérôme; Guillaud, Olivier; Ciocîrlan, Mihai; Salmon, Damien; Lienhart, Isabelle; Lafon, Cyril; Saurin, Jean-Christophe; Ponchon, Thierry

    2015-01-01

    Background: Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract. Methods: We retrospectively report all of the consecutive ESD procedures performed with jet injection of viscous solutions in four centers. Information was collected about the lesion, the procedure, the histological result, and the outcomes for the patient. Results: In total, 45 resections were completed by six operators: five experts and one beginner with only one previous experience in human ESD. Lesions were located in the esophagus (10), the stomach (11), the duodenum (1), the colon (1) and the rectum (22). Average maximal lesion diameter was 4.8 cm (SD 2.4, range 2 – 11 cm), average lesion surface area was 19.8 cm2 (SD 17.7, range 2.2 – 72 cm2), and average duration of procedure was 79.9 min (SD 50.3 min, range 19 – 225 min). ESD could be conducted while the endoscope was retroflexed at its maximum in 26 cases. Four adverse events were observed: two diminutive perforations and two delayed bleeding occurrences treated conservatively. The R0 resection rate was 91.1 %. The catheter was obstructed in six occurrences of bleeding. Conclusion: Endoscopic submucosal dissection using high pressure injection of viscous macromolecular solutions is safe and effective in different parts of the digestive tract. It does not impede working with the endoscope in the maximal retroflexed position. PMID:26356488

  2. MOEMS optical delay line for optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Choudhary, Om P.; Chouksey, S.; Sen, P. K.; Sen, P.; Solanki, J.; Andrews, J. T.

    2014-09-01

    Micro-Opto-Electro-Mechanical optical coherence tomography, a lab-on-chip for biomedical applications is designed, studied, fabricated and characterized. To fabricate the device standard PolyMUMPS processes is adopted. We report the utilization of electro-optic modulator for a fast scanning optical delay line for time domain optical coherence tomography. Design optimization are performed using Tanner EDA while simulations are performed using COMSOL. The paper summarizes various results and fabrication methodology adopted. The success of the device promises a future hand-held or endoscopic optical coherence tomography for biomedical applications.

  3. CGI delay compensation

    NASA Technical Reports Server (NTRS)

    Mcfarland, Richard E.

    1986-01-01

    Computer-generated graphics in real-time helicopter simulation produces objectionable scene-presentation time delays. In the flight simulation laboratory at Ames Research Center, it has been determined that these delays have an adverse influence on pilot performance during aggressive tasks such as nap-of-the-earth (NOE) maneuvers. Using contemporary equipment, computer-generated image (CGI) time delays are an unavoidable consequence of the operations required for scene generation. However, providing that magnitide distortions at higher frequencies are tolerable, delay compensation is possible over a restricted frequency range. This range, assumed to have an upper limit of perhaps 10 or 15 rad/sec, conforms approximately to the bandwidth associated with helicopter handling qualities research. A compensation algorithm is introduced here and evaluated in terms of tradeoffs in frequency responses. The algorithm has a discrete basis and accommodates both a large, constant transport delay interval and a periodic delay interval, as associated with asynchronous operations.

  4. Comparison of the measurements of an experimental endoscope tester with the Dovideq MDE endoscope test system for two hospitals

    NASA Astrophysics Data System (ADS)

    Noordmans, Herke Jan; Nelisse, Martin W.; de Braak, Menno; Dommerholt, Bert; van den Brink, Henk

    2012-03-01

    In minimal invasive surgery, rigid endoscopes are used to view inside the body through natural or artificial made orifices. As the price of a rigid endoscope is high, they are being constantly re-used after a cleaning and steam sterilization procedure at the Department of Central Sterilization. However, due to mechanical, chemical and thermal stresses, endoscopes degrade over time. To determine whether an endoscope still provides sufficient quality, personnel of the Department of Central Sterilization visually inspect the outside and inside of an endoscope. In practice this check is hard as it appears difficult to tell whether an image is good enough as it should be compared to the image of an new endoscope of the same type. Because of the large diversity in endoscopes, the variation of image quality of new endoscope is already so large, that it is difficult to perform this manual check objectively. In this paper we describe the results of using an experimental test bench to measure the optical quality of endoscopes over the years 2007-2011. The system is based on measuring the illumination pathway using a white LED and photo cell and the viewing pathway using a LCD generated test pattern and high resolution camera. The measurements show that endoscopes roughly degrade 20% per year, but also that the variation in degradation is so high and uncorrelated to the type of endoscope that structural measurement of the quality of endoscopes may be a prerequisite. Looking at the system itself, it appeared that although the system had sufficient stability over these years to allow conclusions, it has too much drawbacks to be used at the Department of Central Sterilization, like the stability of the LCD screen, loosing track of endoscopes when they are placed in another basket and the large number of manual steps needed to perform a measurement. For this reasons we present a new design of an endoscope measurement system, called the MDE, a Measurement Device for Endoscopes. It

  5. VARIABLE TIME DELAY MEANS

    DOEpatents

    Clemensen, R.E.

    1959-11-01

    An electrically variable time delay line is described which may be readily controlled simuitaneously with variable impedance matching means coupied thereto such that reflections are prevented. Broadly, the delay line includes a signal winding about a magnetic core whose permeability is electrically variable. Inasmuch as the inductance of the line varies directly with the permeability, the time delay and characteristic impedance of the line both vary as the square root of the permeability. Consequently, impedance matching means may be varied similariy and simultaneously w:th the electrically variable permeability to match the line impedance over the entire range of time delay whereby reflections are prevented.

  6. Ethmoid pneumocele presenting with exophthalmos 15 years after endoscopic sinus surgery

    PubMed Central

    Song, Michelle; Ahn, Sun M.; Reh, Douglas R.

    2015-01-01

    Introduction: A pneumocele is an abnormal dilation of an air-containing sinus beyond the normal margins of bone, with associated bony thinning. A delayed ethmoid pneumocele after sinus surgery has not previously been reported. Methods: A case report of a patient with a delayed ethmoid pneumocele after sinus surgery. The diagnostic workup, operative approach, and postoperative results were evaluated. Results: A 57-year-old female with a history of endoscopic sinus surgery 15 years prior presented with right eye proptosis and severe orbital and facial pressure. A maxillofacial computed tomography showed a markedly expanded air-filled right anterior ethmoid space with a dehiscent lamina papyracea, consistent with a pneumocele. Marsupialization of the pneumocele as well as a revision ethmoidectomy were performed, with a visible return of the orbital contents to a more natural position. The patient experienced worsened diplopia immediately postoperatively that resolved within two weeks. Conclusions: This case demonstrates that a pneumocele can present even years after endoscopic sinus surgery, and acute but temporary development or worsening of diplopia can result from surgical decompression of the pneumocele as the eye returns to its natural position. PMID:26302735

  7. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

    PubMed

    Campo, Rudi; Wattiez, Arnaud; Tanos, Vasilis; Di Spiezio Sardo, Attilio; Grimbizis, Grigoris; Wallwiener, Diethelm; Brucker, Sara; Puga, Marco; Molinas, Roger; O'Donovan, Peter; Deprest, Jan; Van Belle, Yves; Lissens, Ann; Herrmann, Anja; Tahir, Mahmood; Benedetto, Chiara; Siebert, Igno; Rabischong, Benoit; De Wilde, Rudy Leon

    2016-04-01

    In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general.

  8. Gynaecological Endoscopic Surgical Education and Assessment. A diploma programme in gynaecological endoscopic surgery.

    PubMed

    Campo, Rudi; Wattiez, Arnaud; Tanos, Vasilis; Di Spiezio Sardo, Attilio; Grimbizis, Grigoris; Wallwiener, Diethelm; Brucker, Sara; Puga, Marco; Molinas, Roger; O'Donovan, Peter; Deprest, Jan; Van Belle, Yves; Lissens, Ann; Herrmann, Anja; Tahir, Mahmood; Benedetto, Chiara; Siebert, Igno; Rabischong, Benoit; De Wilde, Rudy Leon

    2016-04-01

    In recent years, training and education in endoscopic surgery has been critically reviewed. Clinicians, both surgeons as gynaecologist who perform endoscopic surgery without proper training of the specific psychomotor skills are at higher risk to increased patient morbidity and mortality. Although the apprentice-tutor model has long been a successful approach for training of surgeons, recently, clinicians have recognised that endoscopic surgery requires an important training phase outside the operating theatre. The Gynaecological Endoscopic Surgical Education and Assessment programme (GESEA), recognises the necessity of this structured approach and implements two separated stages in its learning strategy. In the first stage, a skill certificate on theoretical knowledge and specific practical psychomotor skills is acquired through a high stake exam; in the second stage, a clinical programme is completed to achieve surgical competence and receive the corresponding diploma. Three diplomas can be awarded: (a) the Bachelor in Endoscopy; (b) the Minimally Invasive Gynaecological Surgeon (MIGS); and (c) the Master level. The Master level is sub-divided into two separate diplomas: the Master in Laparoscopic Pelvic Surgery and the Master in Hysteroscopy. The complexity of modern surgery has increased the demands and challenges to surgical education and the quality control. This programme is based on the best available scientific evidence and it counteracts the problem of the traditional surgical apprentice tutor model. It is seen as a major step toward standardization of endoscopic surgical training in general. PMID:26946312

  9. [Development of a New Neuro-Endoscope Cylinder for Safer Neuro-Endoscopic Surgery].

    PubMed

    Ishikawa, Toshihito; Endo, Katsuhiro; Endo, Yuji; Sato, Naoki; Ohta, Mamoru

    2016-09-01

    Objective:Successful endoscopic surgery for intracerebral hemorrhage has previously been hampered by impaired visualization during the operation to remove the clot, leading to a relatively low removal efficiency for hematomas. However, in multiple case series, intracerebral hematomas have been reported to be removed using endoscopic visualization. Although using tubular retractors in cranial surgery is one technique to gain access to deep-seated lesions, it is difficult to confirm the depth of the retractor's sheath in the surgical field using only the outer sheath. We built various-sized cylinders, developed by the Japan Science and Technology Agency's(JST)program for revitalization promotion, with scales that are visible during both endoscopic and radiographic procedures. We report the use of these cylinders in clinical cases. Method and Results:The JST-developed cylinders benefit from new techniques for plating and tantalum film implantation used to form tubes made of fluorinated ethylene propylene. We successfully removed various hematomas using these cylinders, as we were able to clearly visualize the border of the brain parenchyma and the depth of the hematoma using the cylinder. Conclusion:Cylinders with visible scales for both endoscopic and radiographic uses developed by the JST programs may provide greater patient safety during endoscopic surgery. We next plan to improve the hardness, length, and smoothness of the groove on the cylinder. PMID:27605475

  10. Endoscopic Ultrasonography in the Diagnosis of Gastric Subepithelial Lesions

    PubMed Central

    Gong, Eun Jeong; Kim, Do Hoon

    2016-01-01

    Subepithelial lesions occasionally found in the stomach of patients undergoing endoscopy may be either benign lesions or tumors with malignant potential. They may also appear due to extrinsic compression. Discrimination of gastric subepithelial lesions begins with meticulous endoscopic examination for size, shape, color, mobility, consistency, and appearance of the overlying mucosa. Accurate diagnosis can be achieved with endoscopic ultrasonography, which provides useful information on the exact size, layer-of-origin, and characteristic morphologic features to support a definitive diagnosis. Endoscopic ultrasonography also aids in the prediction of malignant potential, especially in gastrointestinal stromal tumors. Features of subepithelial lesions identified on endoscopic ultrasonography can be used to determine whether further diagnostic procedures such as endoscopic resection, fine needle aspiration, or core biopsy are required. Endoscopic ultrasonography is a valuable tool for diagnosis and clinical decision making during follow-up of gastric subepithelial lesions. PMID:27744661

  11. Endoscopic Management of Tumor Bleeding from Inoperable Gastric Cancer

    PubMed Central

    Kim, Young-Il

    2015-01-01

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

  12. [ENDOSCOPIC REMOVAL OF TUBERCULUM SELLAE MENINGEOMA THROUGH ENDONASAL TRANSSPHENOIDAL APPROACH].

    PubMed

    Fülöp, Béla; Bella, Zsolt; Palágyi, Péter; Barzó, Pál

    2016-03-30

    Experiences acquired in our department with endoscope assisted microsurgical transsphenoidal pituitary surgery encouraged us to expanded the endoscopic approach to skull base lesions. The endoscopic endonasal transsphenoidal approach proved to be less traumatic to the traditional microsurgical approaches, yet very effective. The endoscopic transsphenoidal technique was applied in a patient havin anterior skull base tumor. The patient was a 49-year-old woman with several months history of left visual defect. The magnetic resonance (MR) scans of the skull revealed a midline anterior fossa space-occupying lesion measuring 21 x 16 x 22 mm located on planum sphenoidale, tuberculum sellae and intrasellar. The tumor compressed both optic nerves and optic chiasm. Total resection of the tumor was achieved by use of endoscopic transnasal, transsphenoidal technique. This is the first reported case of an anterior fossa meningeoma being treated by an endoscopic transsphenoidal technique in Hungary. PMID:27188006

  13. Present status of endoscopic mastectomy for breast cancer

    PubMed Central

    Owaki, Tetsuhiro; Kijima, Yuko; Yoshinaka, Heiji; Hirata, Munetsugu; Okumura, Hiroshi; Ishigami, Simiya; Nerome, Yasuhito; Takezaki, Toshiro; Natsugoe, Shoji

    2015-01-01

    Endoscopy is now being used for breast cancer surgery. Though it is used for mastectomy, lymph node dissection, and breast reconstruction, its prime use is for mastectomy. Because an incision can be placed inconspicuously in the axillary site, a relatively large incision can be created. A retractor with an endoscope, CO2, and an abrasion device with the endoscope are used for operation space security. It is extremely rare that an endoscope is used for lymph node dissection. For breast reconstruction, it may be used for latissimus muscle flap making, but an endoscope is rarely used for other reconstructions. Endoscopic mastectomy is limited to certain institutions and practiced hands, and it has not been significantly developed in breast cancer surgery. On the other hand, endoscopic surgery may be used widely in breast reconstruction. With respect to the spread of robotic surgery, many factors remain uncertain. PMID:26078919

  14. Preliminary results using a flexible endoscope for orbital surgery

    NASA Astrophysics Data System (ADS)

    Eaton, Alexander M.; Braunstein, Richard E.; Schubert, Herman D.; Trokel, Stephen L.; Odel, Jeffery G.; Behrens, Myles M.

    1992-08-01

    A technique for visualizing the optic nerve, the short and long posterior ciliary arteries and nerves, the ophthalmic vein, and the rectus muscles using a flexible endoscope was developed in human cadavers. Previous reports of orbital endoscopy were limited to the use of a rigid endoscope. Potential applications for this new flexible endoscopic technique include the biopsy of orbital tumors, fenestration of the optic nerve sheath with mid-infrared lasers, photocoagulation of orbital tumors, and retrieval of foreign bodies or slipped muscles.

  15. Endoscopic management of adenomatous ampullary lesions

    PubMed Central

    Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; del Rio, Maria Guerra

    2015-01-01

    Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented. PMID:26413485

  16. Endoscopic management of upper urinary tract stones.

    PubMed

    Payne, S R; Ford, T F; Wickham, J E

    1985-10-01

    Since 1981, 525 renal and ureteric calculi have been removed with percutaneous nephrolithotomy (PCN) or transurethral ureteroscopy as the primary modalities of therapy. Successful extraction of the stone at the first attempt was achieved in 92 per cent of cases by PCN and 70 per cent of cases by ureteroscopy, whilst further endoscopic surgery improved the overall success rates to 98 per cent and to 80 per cent respectively. Complication rates from these procedures have both been low as has the morbidity, with most patients leaving hospital within 4 days and returning to work within 2 weeks. The successful development of endoscopic lithotomy and the use of in situ destruction techniques has meant that we now reserve open surgery for difficult multibranched staghorn calculi and ureteric stones embedded in the urothelium. With the advent of extracorporeally generated shockwave lithotripsy it is likely that even these types of stone will be amenable to minimally invasive procedures.

  17. Clinical results of transanal endoscopic microsurgery.

    PubMed

    Buess, G; Kipfmüller, K; Ibald, R; Heintz, A; Hack, D; Braunstein, S; Gabbert, H; Junginger, T

    1988-01-01

    Using the "transanal endoscopic microsurgery" technique, 140 patients were treated at the Department of Surgery in Cologne and Mainz. Of the patients with adenomas, 68.2% had typical symptoms preoperatively. The postoperative hospital attendance was 8.7 days, with an average resection size of 14.4 cm2. The postoperative complication rate was 5%, and there were no deaths related to the technique. In a prospective controlled trial, 2.2% of the patients with adenomas treated endoscopically in Mainz showed recidivation, requiring reoperation. The follow-up rate was 100%. In 30 cases, microscopic examination revealed carcinoma. Radical reoperation in 8 pT1 tumours showed neither remaining tumour nor lymph node metastases. Twelve patients with pT1 carcinoma treated by local surgery alone were recurrence-free with an average follow-up period of 12.3 months. So far, there have been no late results.

  18. Real-time snapshot hyperspectral imaging endoscope.

    PubMed

    Kester, Robert T; Bedard, Noah; Gao, Liang; Tkaczyk, Tomasz S

    2011-05-01

    Hyperspectral imaging has tremendous potential to detect important molecular biomarkers of early cancer based on their unique spectral signatures. Several drawbacks have limited its use for in vivo screening applications: most notably the poor temporal and spatial resolution, high expense, and low optical throughput of existing hyperspectral imagers. We present the development of a new real-time hyperspectral endoscope (called the image mapping spectroscopy endoscope) based on an image mapping technique capable of addressing these challenges. The parallel high throughput nature of this technique enables the device to operate at frame rates of 5.2 frames per second while collecting a (x, y, λ) datacube of 350 × 350 × 48. We have successfully imaged tissue in vivo, resolving a vasculature pattern of the lower lip while simultaneously detecting oxy-hemoglobin. PMID:21639573

  19. Transaxillary endoscopic silicone gel breast augmentation.

    PubMed

    Strock, Louis L

    2010-09-01

    Following the return of silicone gel breast implants to the US market in 2006, augmentation with these implants has become increasingly popular. Surgeons have an array of refined techniques from which to choose when performing these procedures, many of which offer the advantage of reduced or less-obvious postoperative scarring. For obvious reasons, many patients are requesting placement of the implants through incisions that are removed from the breast area (and thereby hidden). The challenge of these approaches is to provide a level of technical control that matches what is afforded with the traditional inframammary approach. The addition of endoscopic assistance has provided a level of tissue visualization and technical control not previously possible with the transaxillary approach, with results that rival those of an inframammary procedure. In this article, the author presents his current operative technique, which has allowed for the routine placement of silicone gel breast implants through a transaxillary incision using endoscopic assistance.

  20. Advances in the Endoscopic Management of Obesity

    PubMed Central

    Behary, Jason; Kumbhari, Vivek

    2015-01-01

    Obesity has become a worldwide epidemic with significant impact on quality of life, morbidity, and mortality rates. Over the past two decades, bariatric surgery has established itself as the most effective and durable treatment for patients with obesity and its associated comorbidities. However, despite the use of minimally invasive techniques, bariatric surgery is associated with complications in approximately 15% of patients, has a substantial cost, and is used by only 1% of patients who are eligible. Therefore, there is a need for effective minimally invasive therapies, which will be utilized by the large proportion of obese patients who are in desperate need of treatment but are not receiving any. Endoscopic approaches to the management of obesity have been developed, with the aim of delivering more effective, durable, and safer methods of weight reduction. In this paper, we review currently available and future endoscopic therapies that will likely join the armamentarium used in the management of obesity. PMID:26106413

  1. Emerging indications of endoscopic radiofrequency ablation

    PubMed Central

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

    2015-01-01

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

  2. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging. PMID:18044620

  3. Major orbital complications of endoscopic sinus surgery

    PubMed Central

    Rene, C; Rose, G; Lenthall, R; Moseley, I

    2001-01-01

    BACKGROUND—The paranasal sinuses are intimately related to the orbit and consequently sinus disease or surgery may cause severe orbital complications. Complications are rare but can result in serious morbidity, the most devastating of which is severe visual loss.
METHODS—A retrospective review was undertaken of four cases of severe orbital trauma during endoscopic sinus surgery.
RESULTS—All the cases suffered medial rectus damage, one had additional injury to the inferior rectus and oblique, and two patients were blinded as a result of direct damage to the optic nerve or its blood supply.
CONCLUSION—Some ophthalmic complications of endoscopic sinus surgery are highlighted, the mechanisms responsible are discussed, and recommendations for prevention, early recognition, and management are proposed. 

 PMID:11316724

  4. Orbital complications in functional endoscopic sinus surgery.

    PubMed

    Corey, J P; Bumsted, R; Panje, W; Namon, A

    1993-11-01

    Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications--including retroorbital hematoma--are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A "management" tree of decision parameters relevant to orbital complications is presented.

  5. Endoscopic imaging of Barrett’s esophagus

    PubMed Central

    Naveed, Mariam; Dunbar, Kerry B

    2016-01-01

    The incidence of esophageal adenocarcinoma (EAC) has dramatically increased in the United States as well as Western European countries. The majority of esophageal adenocarcinomas arise from a backdrop of Barrett’s esophagus (BE), a premalignant lesion that can lead to dysplasia and cancer. Because of the increased risk of EAC, GI society guidelines recommend endoscopic surveillance of patients with BE. The emphasis on early detection of dysplasia in BE through surveillance endoscopy has led to the development of advanced endoscopic imaging technologies. These techniques have the potential to both improve mucosal visualization and characterization and to detect small mucosal abnormalities which are difficult to identify with standard endoscopy. This review summarizes the advanced imaging technologies used in evaluation of BE. PMID:26981177

  6. Endoscopic navigation for minimally invasive suturing.

    PubMed

    Wengert, Christian; Bossard, Lukas; Häberling, Armin; Baur, Charles; Székely, Gábor; Cattin, Philippe C

    2007-01-01

    Manipulating small objects such as needles, screws or plates inside the human body during minimally invasive surgery can be very difficult for less experienced surgeons, due to the loss of 3D depth perception. This paper presents an approach for tracking a suturing needle using a standard endoscope. The resulting pose information of the needle is then used to generate artificial 3D cues on the 2D screen to optimally support surgeons during tissue suturing. Additionally, if an external tracking device is provided to report the endoscope's position, the suturing needle can be tracked in a hybrid fashion with sub-millimeter accuracy. Finally, a visual navigation aid can be incorporated, if a 3D surface is intraoperatively reconstructed from video or registered from preoperative imaging.

  7. Comprehensive review on endonasal endoscopic sinus surgery

    PubMed Central

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  8. Indications and Techniques of Endoscope Assisted Vitrectomy

    PubMed Central

    Marra, Kyle V; Yonekawa, Yoshihiro; Papakostas, Thanos D; Arroyo, Jorge G

    2013-01-01

    The popularization of ophthalmic endoscopy has been promoted by recent technological advancements that increase the number of indications for endoscopy. These advancements have improved the endoscope’s capabilities in its two fundamental surgical advantages: (1) bypassing anterior segment opacities, and (2) visualizing anteriorly positioned structures such as the ciliary bodies and sub-iris space. In this article, the current state of the ophthalmic endoscope is reviewed alongside its growing number of applications in glaucoma, vitreoretinal, and ocular trauma surgery. We describe the role of endoscopy in endocyclophotocoagulation for glaucoma, cyclitic membrane peeling in hypotony, retinal detachment surgery, intraocular foreign body removal, severe endophthalmitis, and pediatric traumatic vitreoretinal surgery. This review examines both the pearls and limitations of the ophthalmic application of endoscopy. In doing so, we hope to provide guidelines for using the endoscope and also to highlight applications of endoscopy that merit further study. PMID:24349675

  9. Palliative Endoscopic Therapy of Esophageal Cancer

    PubMed Central

    Rabenstein, Thomas

    2015-01-01

    Summary Background This is a review of endoscopic therapy in the setting of palliative management of patients suffering from esophageal cancer (EC). Unfortunately, many cases of EC present in a stage of disease in which curative therapy is not possible. The maintenance of quality of life includes the ability to swallow and of oral feeding, pain control, and the prevention of bleeding. Methods A review of the current literature was performed. Results Many endoscopic methods are available for the management of dysphagia, of which dilation, endoluminal tumor destruction, stenting, and brachytherapy are the most common. Conclusion Surgical palliation should be avoided as much as possible since the alternatives show at least the same efficacy and have fewer complications. PMID:26989392

  10. Endoscopic stapling diverticulotomy of pharyngeal pouch.

    PubMed

    Bates, G J; Koay, C B

    1996-03-01

    Endoscopic diverticulotomy (Dohlman's procedure) is a well-established and effective alternative to external diverticulectomy in the treatment of pharyngeal pouch. The division of the common septum between the pouch and the oesophagus is usually performed either with electrocautery or with a laser. We describe a new technique of endoscopic diverticulotomy using a linear cutter stapling gun. This technique has the advantages of being quick and bloodless, avoiding the need for a nasogastric tube, permitting oral intake as early as the first postoperative day and allowing early discharge from hospital. It also has the theoretical advantage over the electrocautery or the laser technique of reducing the risk of fistula formation, mediastinitis and thermal injury to the recurrent laryngeal nerve. PMID:8678451

  11. Endoscopic management of posterior epistaxis: a review.

    PubMed

    McClurg, S W; Carrau, R

    2014-02-01

    The paradigm for the management of epistaxis, specifically posterior epistaxis, has undergone significant changes in the recent past. Recent prospective and retrospective data has shown that the endonasal surgical management of posterior epistaxis is superior to posterior nasal packing and angiography/embolization with regards to various factors including pain, cost-effectiveness, risk and overall control of bleeding. Endonasal endoscopic surgical techniques for posterior epistaxis include direct cauterization and transnasal endoscopic sphenopalatine/ posterior nasal artery ligation or cauterization with or without control of the anterior ethmoidal artery. Despite the evidence provided by the current literature, a universal treatment protocol has not yet been established. This review article provides an up-to-date assessment of the available literature, and presents a structured paradigm for the management of posterior epistaxis.

  12. Endoscopic proximal hamstring repair and ischial bursectomy.

    PubMed

    Dierckman, Brian D; Guanche, Carlos A

    2012-12-01

    With the significant increase in use of the arthroscope around the hip have come several less invasive techniques to manage pathologies around this joint. This technical note with a video details one such technique that allows for the endoscopic management of proximal hamstring tears and chronic ischial bursitis, which until now have been managed exclusively with much larger open approaches. This procedure allows for complete exposure of the posterior aspect of the hip in a safe, minimally invasive fashion. PMID:23766996

  13. Recent Trends in Endoscopic Management of Obesity.

    PubMed

    Štimac, Davor; Klobučar Majanović, Sanja; Ličina, Milan

    2016-10-01

    Obesity remains a tremendous public health, clinical, and scientific challenge globally. Conventional approaches in the management of obesity offer limited potential for sustained weight loss. Bariatric surgery, although it represents the most effective weight loss treatment, has its own risks and is associated with substantial costs and limited patient applicability. Endoscopic weight loss procedures are considered as the major breakthrough in the management of obesity. Endoluminal interventions performed entirely through the gastrointestinal tract have evolved as a result of an attempt to replicate some of the anatomical features and the physiological effects of the traditional weight loss surgery while being reversible, less invasive, and more cost-effective. Restrictive procedures act to decrease gastric volume by space-occupying devices and/or by suturing or stapling techniques that alter gastric anatomy, whereas malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. Other procedures act by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve blocking) or by gastric aspiration. It is important to underline that the majority of endoscopic weight loss procedures are still being evaluated and are not yet available routinely. Even though some of the techniques and devices that have recently emerged have demonstrated promising short-term results, evidence on their safety and long-term efficacy from well-designed and well-conducted research should be given before they can become an inherent part of everyday clinical practice. Given the rapid development of endoscopic weight loss procedures, this review considers the current state and recent trends in endoscopic management of obesity. PMID:27072642

  14. Gastric varices: Classification, endoscopic and ultrasonographic management

    PubMed Central

    Wani, Zeeshan Ahmad; Bhat, Riyaz Ahmad; Bhadoria, Ajeet Singh; Maiwall, Rakhi; Choudhury, Ashok

    2015-01-01

    Gastric varices (GV) are responsible for 10-30% of all variceal hemorrhage. However, they tend to bleed more severely with higher mortality. Around 35-90% rebleed after spontaneous hemostasis. Approximately 50% of patients with cirrhosis of liver harbor gastroesophageal varices. In this review, new treatment modalities in the form of endoscopic treatment options and interventional radiological procedures have been discussed besides discussion on classification and pathophysiology of GV. PMID:26958057

  15. 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

  16. 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

  17. Endoscopic iliotibial band release in snapping hip.

    PubMed

    Zini, Raul; Munegato, Daniele; De Benedetto, Massimo; Carraro, Andrea; Bigoni, Marco

    2013-01-01

    Several open surgical techniques have been used to treat recalcitrant cases of snapping iliotibial band with varying results. Recently, endoscopic techniques have become available. The purpose of this study was to investigate the results of a modified endoscopic iliotibial band release using a longitudinal retrospective case series.
 Fifteen patients (three men and 12 women) with symptomatic external snapping hip were treated with an endoscopic release of the iliotibial band. The average age was 25 years (range 16-37 years). The procedure was performed in the lateral decubitus position using two portals; the iliotibial band was transversally released using a radiofrequency hook probe. The mean follow-up period was 33.8 months (range 12-84 months).
 The snapping phenomenon was overcome in all the patients. The mean pre-op pain VAS score was 5.5 mm (range 5-7 mm) and the mean post-op pain VAS score was 0.53 mm (range 0-2 mm) with a statistically significant reduction with respect to the preoperative value (p<0.0001); sixty percent of the patients were pain-free. The mean postoperative Harris Hip Score was 97.5 (range 94-100). No revision procedures were indicated and all the patients returned to their previous level of activity. The mean patient satisfaction score was, on average, 9.3 mm (range 8-10 mm) on the VAS scale. No complications occurred.
 Endoscopic iliotibial band release is a safe and reproducible technique with excellent results in terms of snapping phenomenon resolution, patient satisfaction, and return to previous level of activity. After strenuous sporting activities 40% of patients complained of very slight pain.

  18. Endoscopic management of a retroperitoneal hydatid cyst.

    PubMed

    Chowbey, Pradeep K; Wadhwa, Atul; Shah, Sumeet; Sharma, Anil; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

    2004-08-01

    Hydatid cyst is a significant health problem in endemic regions. Although progress has been made in medical treatment and interventional radiology techniques, surgery is currently the treatment of choice. The hydatid cysts are known to occur at several unusual sites in the body. With increasing experience in laparoscopy and retroperitoneoscopy, attempts have been made to offer the advantages of minimal access procedures to hydatid disease patients. We present a case report of such a patient whose retroperitoneal hydatid cyst was removed endoscopically.

  19. Retroperitoneal endoscopic debridement for infected peripancreatic necrosis.

    PubMed

    Seifert, H; Wehrmann, T; Schmitt, T; Zeuzem, S; Caspary, W F

    2000-08-19

    Standard management of infected peripancreatic necrosis consists of open surgical debridement and lavage--a traumatic intervention with substantial morbidity and mortality. As an alternative and novel approach with minimum invasiveness, we present fenestration of the gastric wall and debridement of infected necrosis by direct retroperitoneal endoscopy. In three patients, this strategy led to rapid clinical improvement and no serious complications. Transgastric endoscopic therapy may be a less traumatic alternative to surgery and should be further assessed in prospective studies.

  20. Digital time delay

    DOEpatents

    Martin, A.D.

    1986-05-09

    Method and apparatus are provided for generating an output pulse following a trigger pulse at a time delay interval preset with a resolution which is high relative to a low resolution available from supplied clock pulses. A first lumped constant delay provides a first output signal at predetermined interpolation intervals corresponding to the desired high resolution time interval. Latching circuits latch the high resolution data to form a first synchronizing data set. A selected time interval has been preset to internal counters and corrected for circuit propagation delay times having the same order of magnitude as the desired high resolution. Internal system clock pulses count down the counters to generate an internal pulse delayed by an internal which is functionally related to the preset time interval. A second LCD corrects the internal signal with the high resolution time delay. A second internal pulse is then applied to a third LCD to generate a second set of synchronizing data which is complementary with the first set of synchronizing data for presentation to logic circuits. The logic circuits further delay the internal output signal with the internal pulses. The final delayed output signal thereafter enables the output pulse generator to produce the desired output pulse at the preset time delay interval following input of the trigger pulse.

  1. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment.

    PubMed

    Zhu, Linlin; Qin, Jinyu; Wang, Jin; Guo, Tianjiao; Wang, Zijing; Yang, Jinlin

    2016-01-01

    Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist's experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC). PMID:26884753

  2. Endoscopic papillary balloon dilation: revival of the old technique.

    PubMed

    Jeong, Seung Uk; Moon, Sung-Hoon; Kim, Myung-Hwan

    2013-12-01

    Radiologists first described the removal of bile duct stones using balloon dilation in the early 1980s. Recently, there has been renewed interest in endoscopic balloon dilation with a small balloon to avoid the complications of endoscopic sphincterotomy (EST) in young patients undergoing laparoscopic cholecystectomy. However, there is a disparity in using endoscopic balloon papillary dilation (EPBD) between the East and the West, depending on the origin of the studies. In the early 2000s, EST followed by endoscopic balloon dilation with a large balloon was introduced to treat large or difficult biliary stones. Endoscopic balloon dilation with a large balloon has generally been recognized as an effective and safe method, unlike EPBD. However, fatal complications have occurred in patients with endoscopic papillary large balloon dilation (EPLBD). The safety of endoscopic balloon dilation is still a debatable issue. Moreover, guidelines of indications and techniques have not been established in performing endoscopic balloon dilation with a small balloon or a large balloon. In this article, we discuss the issue of conventional and large balloon endoscopic dilation. We also suggest the indications and optimal techniques of EPBD and EPLBD.

  3. Endoscopic Ultrasound-Guided Treatment of Pancreaticocutaneous Fistulas

    PubMed Central

    Haseeb, Abdul; Abu Dayyeh, Barham K.; Levy, Michael J.; Fujii, Larissa L.; Pearson, Randall K.; Chari, Suresh T.; Gleeson, Ferga C.; Peterson, Bret T.; Swaroop Vege, Santhi

    2016-01-01

    Pancreaticocutaneous fistulas (PCFs) may be refractory to medical therapy or endoscopic retrograde cholangopancreaticography. Four patients underwent endoscopic ultrasound-guided management of refractory PCFs, which were internalized by endoscopic ultrasound-guided transmural puncture of the pancreatic duct (n = 2), fistula tract (n = 1), or both (n = 1), with placement of transmural stents providing internal drainage to the stomach (n = 3) or duodenum (n = 1). Drainage from PCFs ceased in all patients, and all percutaneous drains were removed; internal stents were left in place indefinitely. Endoscopic ultrasound-guided interventions may successfully treat PCFs, allowing removal of percutaneous drains, and are an attractive alternative for patients who might otherwise require pancreatic resection.

  4. Endoscopic Treatment of Early Barrett's Neoplasia: Expanding Indications, New Challenges.

    PubMed

    Pech, Oliver

    2016-01-01

    Endoscopic therapy of early Barrett's neoplasia is nowadays the treatment of choice and recommended over surgery in most current guidelines. Recent data suggest radiofrequency ablation of low-grade intraepithelial neoplasia when confirmed by an expert pathologist. Endoscopic therapy of high-grade intraepithelial neoplasia and mucosal Barrett's adenocarcinoma consists of two steps: first endoscopic resection of all visible lesions, and second ablation of the remaining flat Barrett's mucosa to reduce the rate of recurrences and metachronous neoplasia. The preferred ablation method is radiofrequency ablation. In case of Barrett's adenocarcinoma with incipient submucosal invasion, endoscopic treatment can be considered curative when there are no further risk factors present. PMID:27573769

  5. Endoscopic Instruments and Electrosurgical Unit for Colonoscopic Polypectomy

    PubMed Central

    Park, Hong Jun

    2016-01-01

    Colorectal polypectomy is an effective method for prevention of colorectal cancer. Many endoscopic instruments have been used for colorectal polypectomy, such as snares, forceps, endoscopic clips, a Coagrasper, retrieval net, injector, and electrosurgery generator unit (ESU). Understanding the characteristics of endoscopic instruments and their proper use according to morphology and size of the colorectal polyp will enable endoscopists to perform effective polypectomy. I reviewed the characteristics of endoscopic instruments for colorectal polypectomy and their appropriate use, as well as the basic principles and settings of the ESU. PMID:27399313

  6. Endoscopic Resection of Lipoma of the Patellar Tendon

    PubMed Central

    Lui, Tun Hing; Lee, Man Wai

    2015-01-01

    Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during endoscopic debridement in patients with jumper's knee or the tibial insertion during endoscopic debridement in patients with Osgood-Schlatter disease. PMID:25973368

  7. Integrated Multipoint-Laser Endoscopic Airway Measurements by Transoral Approach

    PubMed Central

    Neitsch, Marie; Horn, Iris-Susanne; Hofer, Mathias; Dietz, Andreas; Fischer, Miloš

    2016-01-01

    Objectives. Optical and technical characteristics usually do not allow objective endoscopic distance measurements. So far no standardized method for endoscopic distance measurement is available. The aim of this study was to evaluate the feasibility and accuracy of transoral airway measurements with a multipoint-laser endoscope. Methods. The semirigid endoscope includes a multipoint laser measurement system that projects 49 laser points (wavelength 639 nm, power < 5 mW) into the optical axis of the endoscopic view. Distances, areas, and depths can be measured in real-time. Transoral endoscopic airway measurements were performed on nine human cadavers, which were correlated with CT measurements. Results. The preliminary experiment showed an optimum distance between the endoscope tip and the object of 5 to 6 cm. There was a mean measurement error of 3.26% ± 2.53%. A Spearman correlation coefficient of 0.95 (p = 0.01) was calculated for the laryngeal measurements and of 0.93 (p < 0.01) for the tracheal measurements compared to the CT. Using the Bland-Altman-Plot, the 95% limits of agreement for the laryngeal measurements were satisfactory: −0.76 and 0.93. Conclusions. Integrated multipoint-laser endoscopic measurement is a promising technical supplement, with potential use in diagnostic endoscopy and transoral endoscopic surgery in daily practice. PMID:27022612

  8. Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist’s View

    PubMed Central

    Holmes, Ian; Friedland, Shai

    2016-01-01

    To discuss the rationale for the widespread application of endoscopic mucosal resection (EMR) rather than endoscopic submucosal dissection (ESD) in Western centers. In Western centers, EMR is the treatment of choice for most non-pedunculated colorectal adenomas >2 cm in size. EMR is sufficiently effective and safe to be performed without post-procedure hospitalization. Advances in EMR have led to reduced recurrence rates, and recent studies have demonstrated excellent outcomes with endoscopic treatment of recurrent adenomas. While studies from Asia have demonstrated lower recurrence rates with ESD, concern about the higher perforation risk and lengthy procedure time of ESD are two of the barriers preventing widespread adoption of ESD in the West. EMR is likely to continue as the dominant method for the treatment of large colorectal adenomas in Western centers until the limitations of ESD are overcome. PMID:27561263

  9. Recent trends in endoscopic management of achalasia

    PubMed Central

    Tolone, Salvatore; Limongelli, Paolo; del Genio, Gianmattia; Brusciano, Luigi; Russo, Antonio; Cipriano, Lorenzo; Terribile, Marco; Docimo, Giovanni; Ruggiero, Roberto; Docimo, Ludovico

    2014-01-01

    Esophageal achalasia is a chronic and progressive motility disorder characterized by absence of esophageal body peristalsis associated with an impaired relaxation of lower esophageal sphincter (LES) and usually with an elevated LES pressure, leading to an altered passage of bolus through the esophago-gastric junction. A definitive cure for achalasia is currently unavailable. Palliative treatment options provide only food and liquid bolus intake and relief of symptoms. Endoscopic therapy for achalasia aims to disrupt or weaken the lower esophageal sphincter. Intra-sphincteric injection of botulinum toxin is reserved for elderly or severely ill patients. Pneumatic dilation provides superior results than botulinum toxin injection and a similar medium-term efficacy almost comparable to that attained after surgery. Per oral endoscopic myotomy is a promising option for treating achalasia, but it requires increased experience and further objective and long-term follow up. This article will review different endoscopic treatments in achalasia, and summarize the short-term and long-term outcomes. PMID:25228942

  10. Design of Endoscopic Capsule With Multiple Cameras.

    PubMed

    Gu, Yingke; Xie, Xiang; Li, Guolin; Sun, Tianjia; Wang, Dan; Yin, Zheng; Zhang, Pengfei; Wang, Zhihua

    2015-08-01

    In order to reduce the miss rate of the wireless capsule endoscopy, in this paper, we propose a new system of the endoscopic capsule with multiple cameras. A master-slave architecture, including an efficient bus architecture and a four level clock management architecture, is applied for the Multiple Cameras Endoscopic Capsule (MCEC). For covering more area of the gastrointestinal tract wall with low power, multiple cameras with a smart image capture strategy, including movement sensitive control and camera selection, are used in the MCEC. To reduce the data transfer bandwidth and power consumption to prolong the MCEC's working life, a low complexity image compressor with PSNR 40.7 dB and compression rate 86% is implemented. A chipset is designed and implemented for the MCEC and a six cameras endoscopic capsule prototype is implemented by using the chipset. With the smart image capture strategy, the coverage rate of the MCEC prototype can achieve 98% and its power consumption is only about 7.1 mW. PMID:25376042

  11. Endoscopic therapies of gastroesophageal reflux disease

    PubMed Central

    Iqbal, Atif; Salinas, Vanessa; Filipi, Charles J

    2006-01-01

    The high prevalence of gastroesophageal reflux disease (GERD) in Western societies has accelerated the need for new modalities of treatment. Currently, medical and surgical therapies are widely accepted among patients and physicians. New potent antisecretory drugs and the development of minimally invasive surgery for the management of GERD are at present the pivotal and largely accepted approaches to treatment. The minimally invasive treatment revolution, however, has stimulated several new endoscopic techniques for GERD. Up to now, the data is limited and further studies are necessary to compare the advantages and disadvantages of the various endoscopic techniques to medical and laparoscopic management of GERD. New journal articles and abstracts are continuously being published. The Food and Drug Administration has approved 3 modalities, thus gastroenterologists and surgeons are beginning to apply these techniques. Further trials and device refinements will assist clinicians. This article will present an overview of the various techniques that are currently on study. This review will report the efficacy and durability of various endoscopic therapies for gastroesophageal reflux disease (GERD). The potential for widespread use of these techniques will also be discussed. Articles and abstracts published in English on this topic were retrieved from Pubmed. Due to limited number of studies and remarkable differences between various trials, strict criteria were not used for the pooled data presented, however, an effort was made to avoid bias by including only studies that used off-PPI scoring as baseline and intent to treat. PMID:16718747

  12. Endoscopic laser stereotaxis: management of brain lesions

    NASA Astrophysics Data System (ADS)

    Zamorano, Lucia J.; Chavantes, Maria C.; Moure, Federico; Diaz, Fernando

    1994-05-01

    Image-guided stereotaxis is an accurate and safe method of directing therapy to target volumes defined in 2D multi-planes or 3D perspectives using computer reconstruction of image data. The major limitations of stereotactic techniques are the lack of intraoperative visualization and the ability to directly monitor the procedures, and changes of intracranial coordinates after decompression of cystic lesions or aspiration of cerebrospinal fluid in the management of intraventricular lesions. Stereotactic neuroendoscopy involves integration of rigid-flexible endoscopy and the Nd-YAG laser in 2D/3D multiplanar image-guided stereotactic procedures. The major advantages of endoscopic laser surgery include being minimally invasive (burrhole or small craniotomy surgery), direct intraoperative visualization, hemostasis, evacuation or resection assessment, and wide exploration of intracranial cavities or ventricles. We used endoscopic laser surgery in the management of 202 patients undergoing biopsy, aspiration, resection, and internal decompression of deep and subcortical intracranial lesions, and for different types of fenestration procedures. Image-guidance combined with endoscopic techniques may offer a safe, accurate alternative to conventional neurosurgical procedures in treating small solid, cystic, intraventricular lesions, and in fenestration procedures.

  13. Avoiding Complications in Endoscopic Third Ventriculostomy.

    PubMed

    Yadav, Yad Ram; Parihar, Vijay Singh; Ratre, Shailendra; Kher, Yatin

    2015-11-01

    Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But they are also associated with limitations such as the initial learning curve, proximal blind spot, visual obscurity, difficulty in controlling bleeding, disorientation, and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy and microsurgery are similar, endoscopy requires additional skills. A thorough understanding of endoscopic techniques and their limitations is required to get maximal benefit. Knowledge of possible complications and techniques to avoid such complications can improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able to manage complications and have a second strategy such as a cerebrospinal fluid shunt if ETV fails. It is better to abandon the procedure if there is disorientation or a higher risk of complications such as bleeding or a thick and opaque floor without any clear visualization of anatomy. Attending live workshops, practice on models and simulators, simpler case selection in the initial learning curve, and hands-on cadaveric workshops can reduce complications. Proper case selection, good surgical technique, and better postoperative care are essential for a good outcome in ETV. Although it is difficult to make a preoperative diagnosis of complex hydrocephalus (combination of communicating and obstructive), improving methods to detect the exact type of hydrocephalus before surgery could increase the success rate of ETV and avoid an unnecessary ETV procedure in such cases. PMID:26140421

  14. Novel computer-based endoscopic camera

    NASA Astrophysics Data System (ADS)

    Rabinovitz, R.; Hai, N.; Abraham, Martin D.; Adler, Doron; Nissani, M.; Fridental, Ron; Vitsnudel, Ilia

    1995-05-01

    We have introduced a computer-based endoscopic camera which includes (a) unique real-time digital image processing to optimize image visualization by reducing over exposed glared areas and brightening dark areas, and by accentuating sharpness and fine structures, and (b) patient data documentation and management. The image processing is based on i Sight's iSP1000TM digital video processor chip and Adaptive SensitivityTM patented scheme for capturing and displaying images with wide dynamic range of light, taking into account local neighborhood image conditions and global image statistics. It provides the medical user with the ability to view images under difficult lighting conditions, without losing details `in the dark' or in completely saturated areas. The patient data documentation and management allows storage of images (approximately 1 MB per image for a full 24 bit color image) to any storage device installed into the camera, or to an external host media via network. The patient data which is included with every image described essential information on the patient and procedure. The operator can assign custom data descriptors, and can search for the stored image/data by typing any image descriptor. The camera optics has extended zoom range of f equals 20 - 45 mm allowing control of the diameter of the field which is displayed on the monitor such that the complete field of view of the endoscope can be displayed on all the area of the screen. All these features provide versatile endoscopic camera with excellent image quality and documentation capabilities.

  15. Chicken wing training model for endoscopic microsurgery.

    PubMed

    Jusue-Torres, Ignacio; Sivakanthan, Sananthan; Pinheiro-Neto, Carlos Diogenes; Gardner, Paul A; Snyderman, Carl H; Fernandez-Miranda, Juan C

    2013-10-01

    Objectives To present and validate a chicken wing model for endoscopic endonasal microsurgical skill development. Setting A surgical environment was constructed using a Styrofoam box and measurements from radiological studies. Endoscopic visualization and instrumentation were utilized in a manner to mimic operative setting. Design Five participants were instructed to complete four sequential tasks: (1) opening the skin, (2) exposing the main artery in its neurovascular sheath, (3) opening the neurovascular sheath, and (4) separating the nerve from the artery. Time to completion of each task was recorded. Participants Three junior attendings, one senior resident, and one medical student were recruited internally. Main Outcome Measures Time to perform the surgical tasks measured in seconds. Results The average time of the first training session was 48.8 minutes; by the 10th training session, the average time was 22.4 minutes. The range of improvement was 25.7 minutes to 72.4 minutes. All five participants exhibited statistically significant decrease in time after 10 trials. Kaplan-Meier analysis revealed that an improvement of 50% was achieved by an average of five attempts at the 95% confidence interval. Conclusions The ex vivo chicken wing model is an inexpensive and relatively realistic model to train endoscopic dissection using microsurgical techniques. PMID:24436926

  16. Endoscopic treatment of malignant biliary strictures.

    PubMed

    Rustagi, Tarun; Jamidar, Priya A

    2015-01-01

    Endoscopic stenting is a widely accepted strategy for providing effective drainage in both extrahepatic and intrahepatic malignant strictures. In patients with extrahepatic malignancies, uncovered self-expanding metal stents (SEMS) provide excellent palliation. Hilar malignancies are probably best palliated by placement of uncovered SEMS although some disagreement exists among experts regarding the type and number of stents for optimal palliation. Preoperative biliary drainage (PBD) is commonly performed although a higher risk of complications and the lack of clear benefit raise questions about this practice. Certain groups of patients such as those with markedly elevated bilirubin levels, and in those in whom neoadjuvant therapy is planned, are good candidates for PBD. Considerable controversy exists regarding the optimal method as well as type of stent for PBD in patients with hilar malignancies. Novel endoscopic therapies, including photodynamic therapy and radiofrequency ablation, have emerged as potential adjuvant therapies in the management of malignant bile duct strictures but need further long-term evaluation to establish survival benefit. This review focuses on the current status of endoscopic therapies for malignant biliary obstructions.

  17. Chicken wing training model for endoscopic microsurgery.

    PubMed

    Jusue-Torres, Ignacio; Sivakanthan, Sananthan; Pinheiro-Neto, Carlos Diogenes; Gardner, Paul A; Snyderman, Carl H; Fernandez-Miranda, Juan C

    2013-10-01

    Objectives To present and validate a chicken wing model for endoscopic endonasal microsurgical skill development. Setting A surgical environment was constructed using a Styrofoam box and measurements from radiological studies. Endoscopic visualization and instrumentation were utilized in a manner to mimic operative setting. Design Five participants were instructed to complete four sequential tasks: (1) opening the skin, (2) exposing the main artery in its neurovascular sheath, (3) opening the neurovascular sheath, and (4) separating the nerve from the artery. Time to completion of each task was recorded. Participants Three junior attendings, one senior resident, and one medical student were recruited internally. Main Outcome Measures Time to perform the surgical tasks measured in seconds. Results The average time of the first training session was 48.8 minutes; by the 10th training session, the average time was 22.4 minutes. The range of improvement was 25.7 minutes to 72.4 minutes. All five participants exhibited statistically significant decrease in time after 10 trials. Kaplan-Meier analysis revealed that an improvement of 50% was achieved by an average of five attempts at the 95% confidence interval. Conclusions The ex vivo chicken wing model is an inexpensive and relatively realistic model to train endoscopic dissection using microsurgical techniques.

  18. Esophageal Stricture Prevention after Endoscopic Submucosal Dissection

    PubMed Central

    Jain, Deepanshu; Singhal, Shashideep

    2016-01-01

    Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed. PMID:26949124

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

    PubMed

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

    2016-01-25

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

  20. Gastrointestinal bleeding from Dieulafoy’s lesion: Clinical presentation, endoscopic findings, and endoscopic therapy

    PubMed Central

    Nojkov, Borko; Cappell, Mitchell S

    2015-01-01

    Although relatively uncommon, Dieulafoy’s lesion is an important cause of acute gastrointestinal bleeding due to the frequent difficulty in its diagnosis; its tendency to cause severe, life-threatening, recurrent gastrointestinal bleeding; and its amenability to life-saving endoscopic therapy. Unlike normal vessels of the gastrointestinal tract which become progressively smaller in caliber peripherally, Dieulafoy’s lesions maintain a large caliber despite their peripheral, submucosal, location within gastrointestinal wall. Dieulafoy’s lesions typically present with severe, active, gastrointestinal bleeding, without prior symptoms; often cause hemodynamic instability and often require transfusion of multiple units of packed erythrocytes. About 75% of lesions are located in the stomach, with a marked proclivity of lesions within 6 cm of the gastroesophageal junction along the gastric lesser curve, but lesions can also occur in the duodenum and esophagus. Lesions in the jejunoileum or colorectum have been increasingly reported. Endoscopy is the first diagnostic test, but has only a 70% diagnostic yield because the lesions are frequently small and inconspicuous. Lesions typically appear at endoscopy as pigmented protuberances from exposed vessel stumps, with minimal surrounding erosion and no ulceration (visible vessel sans ulcer). Endoscopic therapy, including clips, sclerotherapy, argon plasma coagulation, thermocoagulation, or electrocoagulation, is the recommended initial therapy, with primary hemostasis achieved in nearly 90% of cases. Dual endoscopic therapy of epinephrine injection followed by ablative or mechanical therapy appears to be effective. Although banding is reportedly highly successful, it entails a small risk of gastrointestinal perforation from banding deep mural tissue. Therapeutic alternatives after failed endoscopic therapy include repeat endoscopic therapy, angiography, or surgical wedge resection. The mortality has declined from about 30

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

    PubMed Central

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

    2016-01-01

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

  2. Safety of direct endoscopic necrosectomy in patients with gastric varices

    PubMed Central

    Storm, Andrew C; Thompson, Christopher C

    2016-01-01

    AIM: To determine the feasibility and safety of transgastric direct endoscopic necrosectomy (DEN) in patients with walled-off necrosis (WON) and gastric varices. METHODS: A single center retrospective study of consecutive DEN for WON was performed from 2012 to 2015. All DEN cases with gastric fundal varices noted on endoscopy, computed tomography (CT) or magnetic resonance imaging (MRI) during the admission for DEN were collected for analysis. In all cases, external urethral sphincter (EUS) with doppler was used to exclude the presence of intervening gastric varices or other vascular structures prior to 19 gauge fine-needle aspiration (FNA) needle access into the cavity. The tract was serially dilated to 20 mm and was entered with an endoscope for DEN. Pigtail stents were placed to facilitate drainage of the cavity. Procedure details were recorded. Comprehensive chart review was performed to evaluate for complications and WON recurrence. RESULTS: Fifteen patients who underwent DEN for WON had gastric varices at the time of their procedure. All patients had an INR < 1.5 and platelets > 50. Of these patients, 11 had splenic vein thrombosis and 2 had portal vein thrombosis. Two patients had isolated gastric varices, type 1 and the remaining 13 had > 5 mm gastric submucosal varices on imaging by CT, MRI or EUS. No procedures were terminated without completing the DEN for any reason. One patient had self-limited intraprocedural bleeding related to balloon dilation of the tract. Two patients experienced delayed bleeding at 2 and 5 d post-op respectively. One required no therapy or intervention and the other received 1 unit transfusion and had an EGD which revealed no active bleeding. Resolution rate of WON was 100% (after up to 2 additional DEN in one patient) and no patients required interventional radiology or surgical interventions. CONCLUSION: In patients with WON and gastric varices, DEN using EUS and doppler guidance may be performed safely. Successful resolution

  3. What can be the criteria of outpatient-based endoscopic resection for colon polyp?

    PubMed Central

    Kim, Hyung Hun; Kim, Sung Eun; Cho, Eun Joo

    2014-01-01

    AIM: To investigate whether out-patient based endoscopic mucosal resection (EMR) for colon polyps ≤ 10 mm is safe. METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors. RESULTS: The size of the polyp (95%CI: 1.096-1.164, P < 0.001) and patients with chronic renal failure (95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multivariate analysis. 95%CI for percent of delayed bleeding according to polyp size was determined for the following conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size > 10 mm, 0.54%-2.08%; size > 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpatient-based EMR for colon polyps ≤ 10 mm. PMID:25324921

  4. Delayed emergence after anesthesia.

    PubMed

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G

    2015-06-01

    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up. PMID:25912729

  5. Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations

    PubMed Central

    Cheon, Jae Hee

    2015-01-01

    Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD. PMID:26018512

  6. Endoscopic assessment and management of early esophageal adenocarcinoma.

    PubMed

    Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

    2014-08-15

    Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett's esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

  7. Endoscopic assessment and management of early esophageal adenocarcinoma

    PubMed Central

    Hammoud, Ghassan M; Hammad, Hazem; Ibdah, Jamal A

    2014-01-01

    Esophageal carcinoma affects more than 450000 people worldwide and the incidence is rapidly increasing. In the United States and Europe, esophageal adenocarcinoma has superseded esophageal squamous cell carcinoma in its incidence. Esophageal cancer has a high mortality rates secondary to the late presentation of most patients at advanced stages. Endoscopic screening is recommended for patients with multiple risk factors for cancer in Barrett’s esophagus. These risk factors include chronic gastroesophageal reflux disease, hiatal hernia, advanced age, male sex, white race, cigarette smoking, and obesity. The annual risk of esophageal cancer is approximately 0.25% for patients without dysplasia and 6% for patients with high-grade dysplasia. Twenty percent of all esophageal adenocarcinoma in the United States is early stage with disease confined to the mucosa or submucosa. The significant morbidity and mortality of esophagectomy make endoscopic treatment an attractive option. The American Gastroenterological Association recommends endoscopic eradication therapy for patients with high-grade dysplasia. Endoscopic modalities for treatment of early esophageal adenocarcinoma include endoscopic resection techniques and endoscopic ablative techniques such as radiofrequency ablation, photodynamic therapy and cryoablation. Endoscopic therapy should be precluded to patients with no evidence of lymphovascular invasion. Local tumor recurrence is low after endoscopic therapy and is predicted by poor differentiation of tumor, positive lymph node and submucosal invasion. Surgical resection should be offered to patients with deep submucosal invasion. PMID:25132925

  8. 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

  9. 21 CFR 884.1660 - Transcervical endoscope (amnioscope) and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Transcervical endoscope (amnioscope) and accessories. 884.1660 Section 884.1660 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND...) Identification. A transcervical endoscope is a device designed to permit direct viewing of the fetus and...

  10. [Endoscopic ultrasonography in diagnosis of surgical treatment of pancreas].

    PubMed

    Starkov, Iu G; Solodinina, E N; Shishin, K V; Plotnikova, L S

    2008-01-01

    Results of endoscopic ultrasonography at 137 patients suspected for pancreas pathology are analyzed. Methodology of endoscopic ultrasonography, semiotics of pancreas surgical diseases, advantages over other diagnostic methods are described. Endosonography is informative method for final diagnosis of different disease of pancreas. Diagnostic value of method and area of its clinical application are described.

  11. Powered instrumentation in functional endoscopic sinus surgery. I: Surgical technique.

    PubMed

    Christmas, D A; Krouse, J H

    1996-01-01

    The use of the microdebrider provides an excellent, safe and thorough technique in functional endoscopic sinus surgery. It provides atraumatic dissection with minimal bleeding which enables decreased surgical time and faster postoperative healing. It is easily learned and requires minimal supplemental instrumentation. We feel that it is a superior technique in the practice of functional endoscopic sinus surgery.

  12. Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results

    PubMed Central

    Cinà, C S; Cinà, M M; Clase, C M

    2007-01-01

    Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls. PMID:19789674

  13. Time delay spectrum conditioner

    DOEpatents

    Greiner, Norman R.

    1980-01-01

    A device for delaying specified frequencies of a multiple frequency laser beam. The device separates the multiple frequency beam into a series of spatially separated single frequency beams. The propagation distance of the single frequency beam is subsequently altered to provide the desired delay for each specific frequency. Focusing reflectors can be utilized to provide a simple but nonadjustable system or, flat reflectors with collimating and focusing optics can be utilized to provide an adjustable system.

  14. Swept group delay measurement

    NASA Technical Reports Server (NTRS)

    Trowbridge, D. L. (Inventor)

    1978-01-01

    Direct recording of group delay measurements on a system under temperature and stress tests employs modulated carrier frequency sweep over an S or X band. Reference path and test paths to separate detectors utilize a power divider e.g., a directional coupler or a hybrid T junction. An initially balanced phase comparator is swept in frequency by modulated carrier over the band of interest for different conditions of temperature and/or mechanical stress to obtain characteristic group delay curves.

  15. Nonintubated Transareolar Endoscopic Thoracic Sympathectomy with a Flexible Endoscope: Experience of 58 Cases

    PubMed Central

    Chen, Jianfeng; Lin, Jianbo; Lin, Min; Li, Xu; Lai, Fancai

    2015-01-01

    Objective: Natural orifice transluminal endoscopic surgery (NOTES) has recently become a hot spot in the field of minimally invasive surgery. But, most of the procedures are still in the early stages of development and limited to animal experiments. Transareolar endoscopic surgery could work as a viable intermediate step before thoracic NOTES. Under intravenous anesthesia without endotracheal intubation, transareolar endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary palmar hyperhidrosis (PPH). Methods: From June 2012 to July 2014, a total of 58 male patients with severe PPH underwent transareolar ETS by use of a flexible endoscope. Under intravenous anesthesia without endotracheal intubation, a flexible endoscope was introduced through the incision on the edge of the areola into the thoracic cavity. The thoracic sympathetic chain was ablated at the level of the fourth rib. Results: All procedures were successfully performed with a mean operating time of 33.6 ± 8.3 min. All patients regained consciousness rapidly and none of them complained about sore throat after surgery. There were no operative mortality and conversion to open procedure. The symptoms of all patients disappeared as soon as the sympathetic chain was cut off. Fifty six patients (96.6%) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner’s syndrome. At 3 months postoperatively, there was no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory hyperhidrosis (CH) appeared in 19 patients. No recurrent symptoms were observed in our study. One year follow-up revealed an excellent cosmetic result and degree of satisfaction. Conclusion: Nonintubated transareolar ETS with a flexible

  16. Delayed voice communication

    NASA Astrophysics Data System (ADS)

    Love, Stanley G.; Reagan, Marcum L.

    2013-10-01

    We present results from simulated deep-space exploration missions that investigated voice communication with significant time delays. The simulations identified many challenges: confusion of sequence, blocked calls, wasted crew time, impaired ability to provide relevant information to the other party, losing track of which messages have reached the other party, weakened rapport between crew and ground, slow response to rapidly changing situations, and reduced situational awareness. These challenges were met in part with additional training; greater attention and foresight; longer, less frequent transmissions; meticulous recordkeeping and timekeeping; and specific alerting and acknowledging calls. Several simulations used both delayed voice and text messaging. Text messaging provided a valuable record of transmissions and allowed messages to be targeted to subsets of the flight and ground crew, but it was a poor choice for high-workload operators such as vehicle drivers and spacewalkers. Even with the foregoing countermeasures, delayed voice communication is difficult. Additional aids such as automatic delay timers and voice-to-text transcription would help. Tests comparing delays of 50 and 300 s unexpectedly revealed that communicating with the shorter delay was just as challenging as with the longer one.

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

    PubMed

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

    1977-05-01

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

  18. Endoscopic management of difficult common bile duct stones

    PubMed Central

    Trikudanathan, Guru; Navaneethan, Udayakumar; Parsi, Mansour A

    2013-01-01

    Endoscopy is widely accepted as the first treatment option in the management of bile duct stones. In this review we focus on the alternative endoscopic modalities for the management of difficult common bile duct stones. Most biliary stones can be removed with an extraction balloon, extraction basket or mechanical lithotripsy after endoscopic sphincterotomy. Endoscopic papillary balloon dilation with or without endoscopic sphincterotomy or mechanical lithotripsy has been shown to be effective for management of difficult to remove bile duct stones in selected patients. Ductal clearance can be safely achieved with peroral cholangioscopy guided laser or electrohydraulic lithotripsy in most cases where other endoscopic treatment modalities have failed. Biliary stenting may be an alternative treatment option for frail and elderly patients or those with serious co morbidities. PMID:23345939

  19. Diamond turning fabrication of an ultra-compact endoscope

    NASA Astrophysics Data System (ADS)

    Huang, Chih-Yu; Liang, Rongguang

    2016-08-01

    In this paper, we propose a technique by integrating mechanical mounts into lens elements to fulfill a self-aligned and self-assembled optical system. To prove this concept, we designed, fabricated, and tested an ultra-compact endoscope that adopts this technique. By taking advantages of the specially designed fixture and observing the interference fringes between the lens and fixture, we developed a method to minimize decenter and tilt between the two surfaces of the endoscope lens during the diamond turning fabrication process. The integrated mechanical mounts provide an easy assembly process for the endoscope system while maintaining high accuracy in system alignment. With the application of heat shrink tube as the endoscope system holder and to block stray light, the proposed endoscope system has the advantages of low cost, compact size, and high imaging quality.

  20. Robust feature tracking for endoscopic pose estimation and structure recovery

    NASA Astrophysics Data System (ADS)

    Speidel, S.; Krappe, S.; Röhl, S.; Bodenstedt, S.; Müller-Stich, B.; Dillmann, R.

    2013-03-01

    Minimally invasive surgery is a highly complex medical discipline with several difficulties for the surgeon. To alleviate these difficulties, augmented reality can be used for intraoperative assistance. For visualization, the endoscope pose must be known which can be acquired with a SLAM (Simultaneous Localization and Mapping) approach using the endoscopic images. In this paper we focus on feature tracking for SLAM in minimally invasive surgery. Robust feature tracking and minimization of false correspondences is crucial for localizing the endoscope. As sensory input we use a stereo endoscope and evaluate different feature types in a developed SLAM framework. The accuracy of the endoscope pose estimation is validated with synthetic and ex vivo data. Furthermore we test the approach with in vivo image sequences from da Vinci interventions.

  1. Image acquisition in laparoscopic and endoscopic surgery

    NASA Astrophysics Data System (ADS)

    Gill, Brijesh S.; Georgeson, Keith E.; Hardin, William D., Jr.

    1995-04-01

    Laparoscopic and endoscopic surgery rely uniquely on high quality display of acquired images, but a multitude of problems plague the researcher who attempts to reproduce such images for educational purposes. Some of these are intrinsic limitations of current laparoscopic/endoscopic visualization systems, while others are artifacts solely of the process used to acquire and reproduce such images. Whatever the genesis of these problems, a glance at current literature will reveal the extent to which endoscopy suffers from an inability to reproduce what the surgeon sees during a procedure. The major intrinsic limitation to the acquisition of high-quality still images from laparoscopic procedures lies in the inability to couple directly a camera to the laparoscope. While many systems have this capability, this is useful mostly for otolaryngologists, who do not maintain a sterile field around their scopes. For procedures in which a sterile field must be maintained, one trial method has been to use a beam splitter to send light both to the still camera and the digital video camera. This is no solution, however, since this results in low quality still images as well as a degradation of the image that the surgeon must use to operate, something no surgeon tolerates lightly. Researchers thus must currently rely on other methods for producing images from a laparoscopic procedure. Most manufacturers provide an optional slide or print maker that provides a hardcopy output from the processed composite video signal. The results achieved from such devices are marginal, to say the least. This leaves only one avenue for possible image production, the videotape record of an endoscopic or laparoscopic operation. Video frame grabbing is at least a problem to which industry has applied considerable time and effort to solving. Our own experience with computerized enhancement of videotape frames has been very promising. Computer enhancement allows the researcher to correct several of the

  2. Endoscopic Management of Osgood-Schlatter Disease

    PubMed Central

    Lui, Tun Hing

    2016-01-01

    Osgood-Schlatter disease is a common cause of anterior knee pain in sports-practicing adolescents. The long-term outcomes have not always been favorable, and some adolescents have persisting knee pain into adulthood. Excision of the ossicle together with debridement of the tibial tuberosity is indicated if the pain is not relieved with conservative measures. An endoscopic technique for excision of the ossicle associated with Osgood-Schlatter disease is reported. It has the advantages of avoidance of painful surgical scars and preservation of the integrity of the patellar tendon, with the potential for improved cosmetic and functional results. PMID:27073771

  3. [Endoscopic ultrasonic diagnosis of esophageal cancer].

    PubMed

    Kouzu, T; Ogino, Y; Isono, K

    1986-08-01

    Endoscopic Ultrasonography (EUS) has been developed rapidly and is becoming a new routine examination of the digestive diseases. In this thesis, the usefulness of EUS with reference to the diagnosis of the depth and the margins of the cancer invasion and the metastatic lymph nodes is described. Furthermore, the judgment of the efficacy of the combined therapy including radiotherapy, chemotherapy and immunotherapy will be possible with EUS. The information from EUS is useful to determine the treatment plan of esophageal cancer. Therefore, EUS is expected to become a preoperative necessary examination of cases with esophageal cancer. PMID:3537360

  4. Endoscopic removal of retained T- tube fragment.

    PubMed

    Chandrasekar, Thoguluva Seshadri; Murugesh, Mallaiyappan; Radhakrishnan, Subbaiah; Sadagopan, Thiruvengadam; Hussain, Abdul Cadar Mohammed Hameed

    2009-01-01

    T-tube usage is common following common bile duct exploration for calculi and other complex biliary surgeries to ensure proper biliary diversion and healing. A 25-year-old woman was referred from a surgical unit with a history of open cholecystectomy and common bile duct exploration for cholelithiasis and choledocholithiasis with T-tube placement in the common bile duct for postoperative biliary diversion. While retrieving the T-tube, it got fractured and the fragment remained in the bile duct. We report a rare case of retained T-tube fragment after T-tube removal that was retrieved endoscopically.

  5. Endoscopic removal of retained T- tube fragment

    PubMed Central

    Chandrasekar, Thoguluva Seshadri; Murugesh, Mallaiyappan; Radhakrishnan, Subbaiah; Sadagopan, Thiruvengadam; Hussain, Abdul cadar Mohammed Hameed

    2009-01-01

    T-tube usage is common following common bile duct exploration for calculi and other complex biliary surgeries to ensure proper biliary diversion and healing. A 25-year-old woman was referred from a surgical unit with a history of open cholecystectomy and common bile duct exploration for cholelithiasis and choledocholithiasis with T-tube placement in the common bile duct for postoperative biliary diversion. While retrieving the T-tube, it got fractured and the fragment remained in the bile duct. We report a rare case of retained T-tube fragment after T-tube removal that was retrieved endoscopically. PMID:21686845

  6. Endoscopic removal of retained T- tube fragment.

    PubMed

    Chandrasekar, Thoguluva Seshadri; Murugesh, Mallaiyappan; Radhakrishnan, Subbaiah; Sadagopan, Thiruvengadam; Hussain, Abdul Cadar Mohammed Hameed

    2009-01-01

    T-tube usage is common following common bile duct exploration for calculi and other complex biliary surgeries to ensure proper biliary diversion and healing. A 25-year-old woman was referred from a surgical unit with a history of open cholecystectomy and common bile duct exploration for cholelithiasis and choledocholithiasis with T-tube placement in the common bile duct for postoperative biliary diversion. While retrieving the T-tube, it got fractured and the fragment remained in the bile duct. We report a rare case of retained T-tube fragment after T-tube removal that was retrieved endoscopically. PMID:21686845

  7. Endoscopic ultrasonography in diseases of the gallbladder.

    PubMed

    O'Neill, Darby E Robinson; Saunders, Michael D

    2010-06-01

    In recent years, endoscopic ultrasonography (EUS) has emerged as an important tool for the diagnosis and management of pancreaticobiliary disease. The close proximity of the echoendoscope to the biliary system allows detailed imaging of the gallbladder and adjacent structures. EUS is useful for the detection of occult cholelithiasis and biliary sludge and in the evaluation of suspected choledocholithiasis. It can be used to classify and predict neoplasia in polypoid lesions of the gallbladder and also to diagnose and stage gallbladder carcinoma. This article reviews the use of EUS in these diseases of the gallbladder.

  8. Percutaneous endoscopic gastrostomy in children: a single center experience

    PubMed Central

    Koca, Tuğba; Sivrice, Ayşe Çiğdem; Dereci, Selim; Duman, Levent; Akçam, Mustafa

    2015-01-01

    Aim: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction. Material and Methods: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files. Results: Forty seven percutaneous endoscopic gastrostomy and percutaneous endoscopic gastrostomy related procedures were performed in 34 children during a three-year period. The median age of the patients was 2.25 years (3 months-16 years, first and third quartiles=1.0–6.0) and the mean body weight was 13.07±8.6 kg (3 kg-47 kg). Before percutaneous endoscopic gastrostomy procedure, the mean weight z score was −2.26±1.2 (−5–0) and the mean height z score was −2.25±0.96 (−3.85–0.98). The follow-up mean height and weight Z scores at the 12th month after the percutaneous endoscopic gastrostomy procedure could be reached in 24 patients. A significant increase in the mean weight Z score from −2.41 to −1,07 (p=0.000) and in the mean height Z score from −2.29 to −1.99 (p=0.000) was found one year after percutaneous endoscopic gastrostomy catheter was placed in these 24 patients. Patients with neurological and metabolic diseases constituted the majority (64.7% and 26.5% respectively). Peritoneal leakage of food was detected in one patient and local stoma infections were detected in three patients after the procedure. During the follow up period, “Buried bumper syndrome” was observed in one patient. Following percutaneous endoscopic gastrostomy, the number of patients using anti-reflux medication increased from 16 (47.1%) to 18 (52.9%) (p=0.62). One patient with cerebral palsy who had aspiration pneumonia after percutaneous endoscopic gastrostomy insertion

  9. Endoscopic and biopsy diagnoses of superficial, nonampullary, duodenal adenocarcinomas

    PubMed Central

    Kakushima, Naomi; Kanemoto, Hideyuki; Sasaki, Keiko; Kawata, Noboru; Tanaka, Masaki; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

    2015-01-01

    AIM: To investigate the accuracy of endoscopic or biopsy diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs). METHODS: Clinicopathological data were reviewed for 84 superficial NADETs from 74 patients who underwent surgery or endoscopic resection between September 2002 and August 2014 at a single prefectural cancer center. Superficial NADETs were defined as lesions confined to the mucosa or submucosa. Demographic and clinicopathological data were retrieved from charts, endoscopic and pathologic reports. Endoscopic reports included endoscopic diagnosis, location, gross type, diameter, color, and presence or absence of biopsy. Endoscopic diagnoses were made by an endoscopist in charge of the examination before biopsy specimens were obtained. Endoscopic images were obtained using routine, front-view, high-resolution video endoscopy, and chromoendoscopy with indigocarmine was performed for all lesions. Endoscopic images were reviewed by at least two endoscopists to assess endoscopic findings indicative of carcinoma. Preoperative diagnoses based on endoscopy and biopsy findings were compared with histological diagnoses of resected specimens. Sensitivity, specificity, and accuracy were assessed for endoscopic diagnosis and biopsy diagnosis. RESULTS: The majority (81%) of the lesions were located in the second portion of the duodenum. The median lesion diameter was 14.5 mm according to final histology. Surgery was performed for 49 lesions from 39 patients, and 35 lesions from 35 patients were endoscopically resected. Final histology confirmed 65 carcinomas, 15 adenomas, and 3 hyperplasias. A final diagnosis of duodenal carcinoma was made for 91% (52/57) of the lesions diagnosed as carcinoma by endoscopy and 93% (42/45) of the lesions diagnosed as carcinoma by biopsy. The sensitivity, specificity, and accuracy of endoscopic diagnoses were 80%, 72%, and 78%, respectively, whereas those of biopsy diagnoses were 72%, 80%, and 74%, respectively

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

    PubMed Central

    Fujihara, Shintaro; Mori, Hirohito; Kobara, Hideki; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Morishita, Asahiro; Izuishi, Kunihiko; Masaki, Tsutomu

    2014-01-01

    Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR) of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES). Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices. PMID:24877148

  11. Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

    PubMed Central

    2013-01-01

    Background Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. Description The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. Conclusions Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis. PMID:24266908

  12. Downhole delay assembly for blasting with series delay

    DOEpatents

    Ricketts, Thomas E.

    1982-01-01

    A downhole delay assembly is provided which can be placed into a blasthole for initiation of explosive in the blasthole. The downhole delay assembly includes at least two detonating time delay devices in series in order to effect a time delay of longer than about 200 milliseconds in a round of explosions. The downhole delay assembly provides a protective housing to prevent detonation of explosive in the blasthole in response to the detonation of the first detonating time delay device. There is further provided a connection between the first and second time delay devices. The connection is responsive to the detonation of the first detonating time delay device and initiates the second detonating time delay device. A plurality of such downhole delay assemblies are placed downhole in unfragmented formation and are initiated simultaneously for providing a round of explosive expansions. The explosive expansions can be used to form an in situ oil shale retort containing a fragmented permeable mass of formation particles.

  13. Delayed stochastic control

    NASA Astrophysics Data System (ADS)

    Hosaka, Tadaaki; Ohira, Toru; Lucian, Christian; Milton, John

    2005-03-01

    Time-delayed feedback control becomes problematic in situations in which the time constant of the system is fast compared to the feedback reaction time. In particular, when perturbations are unpredictable, traditional feedback or feed-forward control schemes can be insufficient. Nonethless a human can balance a stick at their fingertip in the presence of fluctuations that occur on time scales shorter than their neural reaction times. Here we study a simple model of a repulsive delayed random walk and demonstrate that the interplay between noise and delay can transiently stabilize an unstable fixed-point. This observation leads to the concept of ``delayed stochastic control,'' i.e. stabilization of tasks, such as stick balancing at the fingertip, by optimally tuning the noise level with respect to the feedback delay time. References:(1)J.L.Cabrera and J.G.Milton, PRL 89 158702 (2002);(2) T. Ohira and J.G.Milton, PRE 52 3277 (1995);(3)T.Hosaka, T.Ohira, C.Lucian, J.L.Cabrera, and J.G.Milton, Prog. Theor. Phys. (to appear).

  14. Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus

    PubMed Central

    Yadav, Yad R.; Parihar, Vijay S.; Todorov, Mina; Kher, Yatin; Chaurasia, Ishwar D.; Pande, Sonjjay; Namdev, Hemant

    2016-01-01

    Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus. PMID:27695532

  15. Role of endoscopic third ventriculostomy in tuberculous meningitis with hydrocephalus

    PubMed Central

    Yadav, Yad R.; Parihar, Vijay S.; Todorov, Mina; Kher, Yatin; Chaurasia, Ishwar D.; Pande, Sonjjay; Namdev, Hemant

    2016-01-01

    Hydrocephalus is one of the commonest complications of tuberculous meningitis (TBM). It can be purely obstructive, purely communicating, or due to combinations of obstruction in addition to defective absorption of cerebrospinal fluid (CSF). Endoscopic third ventriculostomy (ETV) as an alternative to shunt procedures is an established treatment for obstructive hydrocephalus in TBM. ETV in TBM hydrocephalus can be technically very difficult, especially in acute stage of disease due to inflamed, thick, and opaque third ventricle floor. Water jet dissection can be helpful in thick and opaque ventricular floor patients, while simple blunt perforation is possible in thin and transparent floor. Lumbar peritoneal shunt is a better option for communicating hydrocephalus as compared to VP shunt or ETV. Intraoperative Doppler or neuronavigation can help in proper planning of the perforation to prevent neurovascular complications. Choroid plexus coagulation with ETV can improve success rate in infants. Results of ETV are better in good grade patients. Poor results are observed in cisternal exudates, thick and opaque third ventricle floor, acute phase, malnourished patients as compared to patients without cisternal exudates, thin and transparent third ventricle floor, chronic phase, well-nourished patients. Some of the patients, especially in poor grade, can show delayed recovery. Failure to improve after ETV can be due to blocked stoma, complex hydrocephalus, or vascular compromise. Repeated lumbar puncture can help faster normalization of the raised intracranial pressure after ETV in patients with temporary defect in CSF absorption, whereas lumbar peritoneal shunt is required in permanent defect. Repeat ETV is recommended if the stoma is blocked. ETV should be considered as treatment of choice in chronic phase of the disease in obstructive hydrocephalus.

  16. Advanced endoscopic technologies for colorectal cancer screening

    PubMed Central

    Obstein, Keith L; Valdastri, Pietro

    2013-01-01

    Colorectal cancer is the third most common cancer in men and the second most common cancer in women worldwide. Diagnosing colorectal has been increasingly successful due to advances in technology. Flexible endoscopy is considered to be an effective method for early diagnosis and treatment of gastrointestinal cancer, making it a popular choice for screening programs. However, millions of people who may benefit from endoscopic colorectal cancer screening fail to have the procedure performed. Main reasons include psychological barriers due to the indignity of the procedure, fear of procedure related pain, bowel preparation discomfort, and potential need for sedation. Therefore, an urgent need for new technologies addressing these issues clearly exists. In this review, we discuss a set of advanced endoscopic technologies for colorectal cancer screening that are either already available or close to clinical trial. In particular, we focus on visual-inspection-only advanced flexible colonoscopes, interventional colonoscopes with alternative propulsion mechanisms, wireless capsule colonoscopy, and technologies for intraprocedural bowel cleansing. Many of these devices have the potential to reduce exam related patient discomfort, obviate the need for sedation, increase diagnostic yield, reduce learning curves, improve access to screening, and possibly avert the need for a bowel preparation. PMID:23382621

  17. [Digital imaging and robotics in endoscopic surgery].

    PubMed

    Go, P M

    1998-05-23

    The introduction of endoscopical surgery has among other things influenced technical developments in surgery. Owing to digitalisation, major progress will be made in imaging and in the sophisticated technology sometimes called robotics. Digital storage makes the results of imaging diagnostics (e.g. the results of radiological examination) suitable for transmission via video conference systems for telediagnostic purposes. The availability of digital video technique renders possible the processing, storage and retrieval of moving images as well. During endoscopical operations use may be made of a robot arm which replaces the camera man. The arm does not grow tired and provides a stable image. The surgeon himself can operate or address the arm and it can remember fixed image positions to which it can return if ordered to do so. The next step is to carry out surgical manipulations via a robot arm. This may make operations more patient-friendly. A robot arm can also have remote control: telerobotics. At the Internet site of this journal a number of supplements to this article can be found, for instance three-dimensional (3D) illustrations (which is the purpose of the 3D spectacles enclosed with this issue) and a quiz (http:@appendix.niwi. knaw.nl).

  18. Percutaneous endoscopic lumbar discectomy - early clinical experience.

    PubMed

    Hirano, Yoshitaka; Mizuno, Junichi; Takeda, Masaaki; Itoh, Yasunobu; Matsuoka, Hidenori; Watanabe, Kazuo

    2012-01-01

    We report our early clinical experience with percutaneous endoscopic lumbar discectomy (PELD) for herniated nucleus pulposus (HNP) in the lumbar spine. We introduced PELD to our clinical practice in June 2009. A total of 311 patients with degenerative lumbar spine disease were treated in our hospital up to August 2011. Thirty-seven patients with lumbar HNP were treated by PELD. PELD was carried out under local anesthesia, and the endoscope was continuously irrigated with saline. Twenty-eight patients were treated through the transforaminal approach, 5 were treated through the interlaminar approach, and 4 were treated through the extraforaminal approach. Surgery was discontinued due to uncontrollable intraoperative pain or anatomical inaccessibility in one case of the interlaminar approach and 2 cases of the extraforaminal approach. In the other 34 patients, the elapsed time of surgery was 34 to 103 minutes (mean 62.4 minutes). Extracorporeal blood loss was insignificant. Immediate symptom relief was achieved in all patients, and postoperative magnetic resonance imaging revealed sufficient removal of the HNP. The length of the postoperative hospital stay was 1 or 2 days in all patients. The surgical method of PELD is completely different from percutaneous nucleotomy, and the aim is to directly remove the HNP with minimum damage to the musculoskeletal structure. Although this study is based on our early clinical outcomes, PELD seemed to be a promising minimally invasive surgery for HNP in the lumbar spine. PMID:23006872

  19. Coblation assisted endoscopic juvenile nasopharyngeal angiofibroma resection.

    PubMed

    Ruiz, Jose W; Saint-Victor, Sandra; Tessema, Belachew; Eloy, Jean Anderson; Anstead, Amy

    2012-03-01

    To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150 min and the estimated blood losses were 150, 400, and 130 mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9 mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.

  20. Compact laser illumination system for endoscopic interventions.

    PubMed

    Blase, Bastian

    2015-08-01

    External cold light sources as well as LEDs are commonly used for abdominal illumination in minimally invasive surgery. Still, both feature certain disadvantages. A new illumination system for endoscopes based on laser diodes is placed in the handle. No external light cables are needed. High conversion and coupling efficiencies and small package size allow for several diodes to be integrated, enabling color mixing and the adjustment of color temperatures. An optical module to collimate and combine the light is described. The heat to be dissipated is stored in a passive latent heat storage based on phase change materials surrounding the optical module. Thereby, operation time is considerably extended, as the handle's temperature is stabilized. To reduce the negative effect of coherent light on optical rough surfaces leading to patterns of spots, several devices for speckle reduction are developed and tested. By combining these components, an assembly of a powerful RGB laser light module for the integration in standard sized endoscopes is formed. PMID:26737628

  1. [Endoscopic surgery of vocal cord cancers].

    PubMed

    Kleinsasser, O; Glanz, H; Kimmich, T

    1988-10-01

    Controversy began in the last century as to whether endoscopic surgery for vocal cord carcinoma carries an unnecessary risk for the patient. This controversy has been renewed since microlaryngoscopy offered the possibility of precise endoscopic resection of a vocal cord carcinoma. The most decisive prerequisites are careful assessment and adherence to strict indications. We only remove small carcinomas arising on freely mobile vocal cords by endoscopy, if the tumour is fully visible through a larger calibre operating laryngoscope. We prefer to use conventional microsurgical instruments rather than the laser. The specimen should be taken in one piece and be subjected to histological examination. Every patient must be closely followed up. A total of 76 patients with carcinomata in situ (Tis a, Tis b) and microinvasive carcinomas (T 1a, T 1b) have been followed for up to 8 years. So far not a single patient has lost his life, his larynx or his voice, or needed an additional external operation or irradiation. The results of endolaryngeal microsurgery for smaller vocal cord tumours are achieved with a minimum cost in time and money, and the least possible burden for the patient. They are scarcely inferior to primary irradiation with respect to the voice and are definitely better with respect to cure. However such results are only achieved in very carefully selected cases.

  2. Disposable sheath that facilitates endoscopic Raman spectroscopy.

    PubMed

    Wang, Wenbo; Short, Michael; Tai, Isabella T; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  3. Hydatid Cyst Diagnosed by Endoscopic Ultrasound

    PubMed Central

    Castro-Poças, F.; Araújo, Tarcísio; Coelho, André; Silva, Donzilia; Pedroto, Isabel

    2016-01-01

    A 69-year-old female with unremarkable past history underwent endoscopy for dyspepsia. She denied weight loss or anorexia. Upper endoscopy revealed a bulge in the lesser curvature and posterior wall of the stomach with 4-5 cm. Endoscopic ultrasound was performed which showed a heterogeneous lesion, anechogenic in the major part, with a floating membrane inside, the greatest diameter of 90.8 × 17.2 mm, originated in the left liver lobe. Surgical resection was performed. Pathologic examination revealed a cystic lesion with an acellular thick fibrous wall, surrounded by a conspicuous inflammatory reaction. The cyst wall revealed a characteristic lamellar pattern of the fibers. In the internal surface of the lesion, there were remains of membranous structures, amidst which a vestigial Protoscolex was noted. In the presented case, a floating membrane was observed, which is a pathognomonic feature, establishing the diagnosis of hydatid cyst type 3. Fine needle aspiration guided by ultrasound was not performed due to the certainty in the diagnosis. To the authors' knowledge, these are the first images by endoscopic ultrasound of hydatid cyst of liver presented as a bulge in the stomach with pathognomonic features, which allowed the definitive diagnosis with no need for further diagnostic tests. PMID:27446863

  4. Disposable sheath that facilitates endoscopic Raman spectroscopy

    NASA Astrophysics Data System (ADS)

    Wang, Wenbo; Short, Michael; Tai, Isabella T.; Zeng, Haishan

    2016-02-01

    In vivo endoscopic Raman spectroscopy of human tissue using a fiber optic probe has been previously demonstrated. However, there remain several technical challenges, such as a robust control over the laser radiation dose and measurement repeatability during endoscopy. A decrease in the signal to noise was also observed due to aging of Raman probe after repeated cycles of harsh reprocessing procedures. To address these issues, we designed and tested a disposable, biocompatible, and sterile sheath for use with a fiber optic endoscopic Raman probe. The sheath effectively controls contamination of Raman probes between procedures, greatly reduces turnaround time, and slows down the aging of the Raman probes. A small optical window fitted at the sheath cap maintained the measurement distance between Raman probe end and tissue surface. To ensure that the sheath caused a minimal amount of fluorescence and Raman interference, the optical properties of materials for the sheath, optical window, and bonding agent were studied. The easy-to-use sheath can be manufactured at a moderate cost. The sheath strictly enforced a maximum permissible exposure standard of the tissue by the laser and reduced the spectral variability by 1.5 to 8.5 times within the spectral measurement range.

  5. Hemostasis in Endoscopic Endonasal Skull Base Surgery

    PubMed Central

    Vaz-Guimaraes, Francisco; Su, Shirley Y.; Fernandez-Miranda, Juan C.; Wang, Eric W.; Snyderman, Carl H.; Gardner, Paul A.

    2015-01-01

    William Halsted established the basic principles of modern surgical technique highlighting the importance of meticulous hemostasis and careful tissue handling. These concepts hold true today and are even more critical for endoscopic visualization, making hemostasis one of the most relevant cornerstones for the safe practice of endoscopic endonasal surgery (EES) of the skull base. During preoperative assessment, patients at higher risk for serious hemorrhagic complications must be recognized. From an anatomical point of view, EES can be grossly divided in two major components: sinonasal surgery and sellar-cranial base surgery. This division affects the choice of appropriate technique for control of bleeding that relies mainly on the source of hemorrhage, the tissue involved, and the proximity of critical neurovascular structures. Pistol-grip or single-shaft instruments constitute the most important and appropriately designed instruments available for EES. Electrocoagulation and a variety of hemostatic materials are also important tools and should be applied wisely. This article describes the experience of our team in the management of hemorrhagic events during EES with an emphasis on technical nuances. PMID:26225320

  6. Endoscopic/Microscopic Approach to Sphenopetroclival Complex

    PubMed Central

    Goravalingappa, Ravi; Han, J.C.; Mangiardi, John; Levenson, Mark

    1999-01-01

    A dilemma presents itself to the otoneurologist and neurosurgeon when determining the least invasive surgical approach to giant cholesterol cysts (GCC) of the petrous apex of the temporal bone. These lesions can be diagnosed with a fair degree of certainty with imaging studies. Transmastoid and subcochlear approaches may be inadequate to access these lesions, and the transcochlear approach results in the sacrifice of hearing. A minimally invasive, combined microscopic and endoscopic sublabial transsphenoid approach to drain and marsupalize these lesions has been chosen by the authors in those cases that are anatomically possible. The purpose of this article is to establish the feasibility of exenterating anterior petrous apex cells by way of this approach, and to better conceptualize the anatomy of the Spheno-Petro-Clival Complex (SPC). Ten Fresh cadaveric “whole head” specimens were dissected with, endoscopic/microscopic control, through midline, sublabial, transseptal, and transsphenoidal routes to the petrous apex. The three-dimensional relationships of the sphenoid sinus, petrous apex, and the clivus were further demonstrated by dissections of the same specimens from the posterior fossa. Sagittal cut sections were also performed. After confirming the feasibility of this approach by dissections, the technique was adopted for performing drainage of GCC of the petrous apex in clinical cases. PMID:17171079

  7. [Digital imaging and robotics in endoscopic surgery].

    PubMed

    Go, P M

    1998-05-23

    The introduction of endoscopical surgery has among other things influenced technical developments in surgery. Owing to digitalisation, major progress will be made in imaging and in the sophisticated technology sometimes called robotics. Digital storage makes the results of imaging diagnostics (e.g. the results of radiological examination) suitable for transmission via video conference systems for telediagnostic purposes. The availability of digital video technique renders possible the processing, storage and retrieval of moving images as well. During endoscopical operations use may be made of a robot arm which replaces the camera man. The arm does not grow tired and provides a stable image. The surgeon himself can operate or address the arm and it can remember fixed image positions to which it can return if ordered to do so. The next step is to carry out surgical manipulations via a robot arm. This may make operations more patient-friendly. A robot arm can also have remote control: telerobotics. At the Internet site of this journal a number of supplements to this article can be found, for instance three-dimensional (3D) illustrations (which is the purpose of the 3D spectacles enclosed with this issue) and a quiz (http:@appendix.niwi. knaw.nl). PMID:9627450

  8. 3-D video techniques in endoscopic surgery.

    PubMed

    Becker, H; Melzer, A; Schurr, M O; Buess, G

    1993-02-01

    Three-dimensional visualisation of the operative field is an important requisite for precise and fast handling of open surgical operations. Up to now it has only been possible to display a two-dimensional image on the monitor during endoscopic procedures. The increasing complexity of minimal invasive interventions requires endoscopic suturing and ligatures of larger vessels which are difficult to perform without the impression of space. Three-dimensional vision therefore may decrease the operative risk, accelerate interventions and widen the operative spectrum. In April 1992 a 3-D video system developed at the Nuclear Research Center Karlsruhe, Germany (IAI Institute) was applied in various animal experimental procedures and clinically in laparoscopic cholecystectomy. The system works with a single monitor and active high-speed shutter glasses. Our first trials with this new 3-D imaging system clearly showed a facilitation of complex surgical manoeuvres like mobilisation of organs, preparation in the deep space and suture techniques. The 3-D-system introduced in this article will enter the market in 1993 (Opticon Co., Karlsruhe, Germany. PMID:8050009

  9. Hydatid Cyst Diagnosed by Endoscopic Ultrasound.

    PubMed

    Castro-Poças, F; Araújo, Tarcísio; Coelho, André; Silva, Donzilia; Pedroto, Isabel

    2016-01-01

    A 69-year-old female with unremarkable past history underwent endoscopy for dyspepsia. She denied weight loss or anorexia. Upper endoscopy revealed a bulge in the lesser curvature and posterior wall of the stomach with 4-5 cm. Endoscopic ultrasound was performed which showed a heterogeneous lesion, anechogenic in the major part, with a floating membrane inside, the greatest diameter of 90.8 × 17.2 mm, originated in the left liver lobe. Surgical resection was performed. Pathologic examination revealed a cystic lesion with an acellular thick fibrous wall, surrounded by a conspicuous inflammatory reaction. The cyst wall revealed a characteristic lamellar pattern of the fibers. In the internal surface of the lesion, there were remains of membranous structures, amidst which a vestigial Protoscolex was noted. In the presented case, a floating membrane was observed, which is a pathognomonic feature, establishing the diagnosis of hydatid cyst type 3. Fine needle aspiration guided by ultrasound was not performed due to the certainty in the diagnosis. To the authors' knowledge, these are the first images by endoscopic ultrasound of hydatid cyst of liver presented as a bulge in the stomach with pathognomonic features, which allowed the definitive diagnosis with no need for further diagnostic tests. PMID:27446863

  10. The stomach after surgery. An endoscopic perspective.

    PubMed Central

    Bowden, T A; Hooks, V H; Mansberger, A R

    1983-01-01

    Twenty-five per cent of the authors' total upper endoscopy experience since 1974 has been in patients who have had upper gastrointestinal tract surgery. The observations from 617 examinations in 400 of these patients is reviewed. Pain or nausea and vomiting was a common presenting symptom. Multiple complaints were frequent. Gastritis was the most common endoscopic finding present in 127 patients (32%). Biopsy yielded an 89% histologic confirmation of the endoscopic perception. Coexisting mucosal pathology was common, with 39% of the patients having two or more abnormalities. X-ray in 190 patients had only a 30% accuracy rate and a frequent occurrence of false negatives (46%). Bezoars and intraluminal sutures were seen commonly and endoscopy provided a therapeutic choice for enzyme injection of the bezoar and removal of the sutures. Endoscopy provided a method of evaluation of our highly selective vagotomy technique; 96% of our patients with ulceration at the time of surgery were healed by endoscopy and 93% had active antral-pyloric function. PMID:6859976

  11. Endoscopic management of complications of chronic pancreatitis

    PubMed Central

    Dumonceau, Jean-Marc; Macias-Gomez, Carlos

    2013-01-01

    Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis (CP). For CP-related, uncomplicated, pancreatic pseudocysts (PPC), endoscopy is the first-choice therapeutic option. Recent advances have focused on endosonography-guided PPC transmural drainage, which tends to replace the conventional, duodenoscope-based coma immediately approach. Ancillary material is being tested to facilitate the endosonography-guided procedure. In this review, the most adequate techniques depending on PPC characteristics are presented along with supporting evidence. For CP-related biliary obstructions, endoscopy and surgery are valid therapeutic options. Patient co-morbidities (e.g., portal cavernoma) and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted option. Malignancy should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary strictures. In endoscopy, the gold standard technique consists of placing simultaneous, multiple, side-by-side, plastic stents for a one-year period. Fully covered self-expandable metal stents are challenging this method and have provided 50% mid-term success. PMID:24259962

  12. Advanced endoscopic submucosal dissection with traction

    PubMed Central

    Imaeda, Hiroyuki; Hosoe, Naoki; Kashiwagi, Kazuhiro; Ohmori, Tai; Yahagi, Naohisa; Kanai, Takanori; Ogata, Haruhiko

    2014-01-01

    Endoscopic submucosal dissection (ESD) has been established as a standard treatment for early stage gastric cancer (EGC) in Japan and has spread worldwide. ESD has been used not only for EGC but also for early esophageal and colonic cancers. However, ESD is associated with several adverse events, such as bleeding and perforation, which requires more skill. Adequate tissue tension and clear visibility of the tissue to be dissected are important for effective and safe dissection. Many ESD methods using traction have been developed, such as clip-with-line method, percutaneous traction method, sinker-assisted method, magnetic anchor method, external forceps method, internal-traction method, double-channel-scope method, outerroute method, double-scope method, endoscopic-surgical-platform, and robot-assisted method. Each method has both advantages and disadvantages. Robotic endoscopy, enabling ESD with a traction method, will become more common due to advances in technology. In the near future, simple, noninvasive, and effective ESD using traction is expected to be developed and become established as a worldwide standard treatment for superficial gastrointestinal neoplasias. PMID:25031787

  13. Approach to the endoscopic resection of duodenal lesions

    PubMed Central

    Gaspar, Jonathan P; Stelow, Edward B; Wang, Andrew Y

    2016-01-01

    Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner’s gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum. PMID:26811610

  14. 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

  15. Feasibility of Piezoelectric Endoscopic Transsphenoidal Craniotomy: A Cadaveric Study

    PubMed Central

    Tomazic, Peter Valentin; Gellner, Verena; Koele, Wolfgang; Hammer, Georg Philipp; Braun, Eva Maria; Gerstenberger, Claus; Clarici, Georg; Holl, Etienne; Braun, Hannes; Stammberger, Heinz; Mokry, Michael

    2014-01-01

    Objective. Endoscopic transsphenoidal approach has become the gold standard for surgical treatment of treating pituitary adenomas or other lesions in that area. Opening of bony skull base has been performed with burrs, chisels, and hammers or standard instruments like punches and circular top knives. The creation of primary bone flaps—as in external craniotomies—is difficult.The piezoelectric osteotomes used in the present study allows creating a bone flap for endoscopic transnasal approaches in certain areas. The aim of this study was to prove the feasibility of piezoelectric endoscopic transnasal craniotomies. Study Design. Cadaveric study. Methods. On cadaveric specimens (N = 5), a piezoelectric system with specially designed hardware for endonasal application was applied and endoscopic transsphenoidal craniotomies at the sellar floor, tuberculum sellae, and planum sphenoidale were performed up to a size of 3–5 cm2. Results. Bone flaps could be created without fracturing with the piezoosteotome and could be reimplanted. Endoscopic handling was unproblematic and time required was not exceeding standard procedures. Conclusion. In a cadaveric model, the piezoelectric endoscopic transsphenoidal craniotomy (PETC) is technically feasible. This technique allows the surgeon to create a bone flap in endoscopic transnasal approaches similar to existing standard transcranial craniotomies. Future trials will focus on skull base reconstruction using this bone flap. PMID:24689037

  16. Adjunctive use of mitomycin C on endoscopic lacrimal surgery

    PubMed Central

    Anadolu, Y.; Akturk, T.

    1998-01-01

    AIMS—Endoscopic endonasal dacryocystorhinostomy (DCR) has some advantages over external DCR as a less invasive method with no skin incisions. But the success rate of the operation has not reached the level of external method. In this study, a wound healing inhibitor mitomycin C was used intraoperatively to prevent the closure of the osteum after the operation.
METHODS—Endoscopic endonasal DCR was performed on 40 eyes of 39 patients (26 female, 13 male). Mitomycin C was applied to the ostium in 14 of 23 patients who had undergone primary endoscopic DCR by means of a microdrill and in eight of 17 patients who had a revision endoscopic DCR secondary to a previously failed external DCR.
RESULTS—The postoperative follow up period was 9-27 (mean 18.2) months. The success rate of endoscopic DCR with intraoperative mitomycin C was 77.3%, whereas the success rate of endoscopic DCR without mitomycin C was 77.8%. The statistical analysis did not show a difference between the two groups according to the ostium size and their success rates.
CONCLUSIONS—Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

 Keywords: mytomycin C; lacrimal surgery; dacryocystorhinostomy PMID:9536884

  17. Endoscopic Identification of the Pharyngeal (Palatovaginal) Canal: An Overlooked Area

    PubMed Central

    Herzallah, Islam R.; Amin, Sameh; El-Hariri, Mona A.; Casiano, Roy R.

    2012-01-01

    Objective The pharyngeal or palatovaginal canal (PC) is a small tunnel that lies between the sphenoid process of the palatine bone and the vaginal process of the sphenoid bone. Currently, little endoscopic information is available about this region. Design and Setting Endoscopic endonasal cadaveric study. Subjects and Methods Twenty sides in 10 adult cadaver heads were studied endoscopically. The sphenopalatine foramen (SPF) and the adjacent pterygopalatine fossa were exposed. Dissection medial to the vidian canal demonstrated a tunnel that runs posteromedially in the sphenoid floor. Endoscopic data were documented. Additionally, canal measurements were obtained on 20 sides from coronal CT scans of paranasal sinuses. Results The PC was identifiable in 85% of the sides, although thickness of its bony wall was variable. The endoscopic relationship of the canal and its artery with other landmarks is described. Radiologically, the diameter of the PC averaged 1.7 mm, and the mean distance from the PC to the vidian canal was 3.78 mm. Conclusion The current study provides a novel endoscopic identification of an overlooked canal. The pharyngeal artery can be a source of bleeding during extended endoscopic procedures. The PC itself could be a place for finger-like projections of anatomically related neoplasms. PMID:24083128

  18. Image Guided Endoscopic Evacuation of Spontaneous Intracerebral Hemorrhage

    PubMed Central

    Miller, Chad M; Vespa, Paul; Saver, Jeffrey L; Kidwell, Chelsea S; Carmichael, Stanley T.; Alger, Jeffry; Frazee, John; Starkman, Sid; Liebeskind, David; Nenov, Valeriy; Elashoff, Robert; Martin, Neil

    2014-01-01

    Background Spontaneous intracerebral hemorrhage (ICH) is a devastating disease with high morbidity and mortality. ICH lacks an effective medical or surgical treatment despite the acknowledged pathophysiological benefits of achieved hemostasis and clot removal. Image guided stereotactic endoscopic hematoma evacuation is a promising minimally invasive approach designed to limit operative injury and maximize hematoma removal. Methods A single center randomized controlled trial was designed to assess the safety and efficacy of stereotactic hematoma evacuation compared to best medical management. Patients were randomized within 24 hours of hemorrhage in a 3:2 fashion to best medical management plus endoscopic hematoma evacuation or best medical management alone. Data was collected to assess efficacy and safety of hematoma evacuation and to identify procedural components requiring technical improvement. Results 10 patients have been enrolled and randomized to treatment. Six patients underwent endoscopic evacuation with a hematoma volume reduction of 80% +/−13 at 24 hours post procedure. The medical arm demonstrated a hematoma enlargement of 78% +/−142 during this same period. Rehemorrhage rates and deterioration rates were similar in the two groups. Mortality was 20% in the endoscopic group and 50% in the medical treatment cohort. The endoscopic technique was shown to be effective in identification and evacuation of hematomas while reduction in the number of endoscopic passes and maintenance of hemostasis require further study. Conclusion Image guided stereotactic endoscopic hematoma removal is a promising minimally invasive technique that is effective in immediate hematoma evacuation. This technique deserves further investigation to determine its role in ICH management. PMID:18424298

  19. Clinical characteristics and management of gastric tube cancer with endoscopic submucosal dissection

    PubMed Central

    Mukasa, Michita; Takedatsu, Hidetoshi; Matsuo, Ken; Sumie, Hiroaki; Yoshida, Hikaru; Hinosaka, Atsushi; Watanabe, Yasutomo; Tsuruta, Osamu; Torimura, Takuji

    2015-01-01

    AIM: To identify the characteristics of gastric tube cancer (GTC) and the complications associated with endoscopic submucosal dissection (ESD) for GTC. METHODS: Between 2007 and 2012, 11 individuals with early gastric cancer in the reconstructed gastric tube after esophagectomy who underwent ESD in this hospital were studied. The characteristics of GTC were identified, and the complications of ESD for GTC were analyzed at three phases: preoperative, intraoperative, and postoperative. RESULTS: A total of 11 consecutive patients with 11 GTCs were selected for this study. All cases underwent en bloc resections by ESD. The median procedure time was 142 min. The average GTC diameter was 26.1 mm, and the average size of the resected lesions was 45.5 mm. The histopathological diagnosis in all cases was a differentiated adenocarcinoma. In the preoperative phase, anastomotic strictures (5/11, 45%) and food residues (4/11, 36.4%) in the gastric tube were the main complications. In the intraoperative phase, bleeding was observed in 5 cases (45%). The postoperative complications observed were delayed bleeding in 2 cases (18.2%) and stenosis in one case (9.1%). The case with stenosis was successfully treated using endoscopic balloon dilatation. CONCLUSION: Minor complications were frequently observed. However, all GTCs underwent en bloc resection with ESD without any serious complications. ESD is considered a useful treatment for GTC. PMID:25624726

  20. Endoscopic submucosal dissection of colorectal neoplasia located on the suture line of anastomosis.

    PubMed

    Horii, Joichiro; Uraoka, Toshio; Goto, Osamu; Ishii, Hiroyuki; Shimoda, Masayuki; Yahagi, Naohisa

    2014-08-01

    Although endoscopic submucosal dissection (ESD) can remove gastrointestinal neoplasia even with severe fibrosis into the submucosa, the safety and efficacy of ESD for colorectal neoplasia (CRN) located on the suture line of anastomosis (SLA) has not been assessed. The aim of this study was to evaluate the feasibility of ESD for CRN located on the SLA, performed by a highly skilled endoscopist. Three consecutive patients with CRN located on the SLA were treated with ESD. In all cases, ESD was safely performed without any adverse events. The median tumor size of the resected CRN was 30 mm (range 12-75 mm) and the median procedure time was 150 min (range 50-150 min). Curative resection was achieved in two cases without local recurrence during a 12-month observation period. In one case, the CRN were resected in an almost en bloc fashion, but a decision was made to spare the edge of the CRN that was directly on the SLA in order to avoid delayed perforation, and this edge was instead removed with hemostatic forceps. Although the surveillance colonoscopy revealed a small residual neoplasia, it was curatively treated by endoscopically. In all cases, ESD managed to avoid the need for repetitive surgery. This case series suggests the feasibility of ESD performed by a highly skilled endoscopist as a curative treatment for the CRN located on the SLA.

  1. Percutaneous transgastric endoscopic tube ileostomy in a porcine survival model

    PubMed Central

    Shi, Hong; Chen, Su-Yu; Wang, Yong-Guang; Jiang, Sheng-Jun; Cai, He-Li; Lin, Kai; Xie, Zhao-Fei; Dong, Fen-Fang

    2016-01-01

    AIM To introduce natural orifice transgastric endoscopic surgery (NOTES) tube ileostomy using pelvis-directed submucosal tunneling endoscopic gastrostomy and endoscopic tube ileostomy. METHODS Six live pigs (three each in the non-survival and survival groups) were used. A double-channeled therapeutic endoscope was introduced perorally into the stomach. A gastrostomy was made using a 2-cm transversal mucosal incision following the creation of a 5-cm longitudinal pelvis-directed submucosal tunnel. The pneumoperitoneum was established via the endoscope. In the initial three operations of the series, a laparoscope was transumbilically inserted for guiding the tunnel direction, intraperitoneal spatial orientation and distal ileum identification. Endoscopic tube ileostomy was conducted by adopting an introducer method and using a Percutaneous Endoscopic Gastrostomy Catheter Kit equipped with the Loop Fixture. The distal tip of the 15 Fr catheter was placed toward the proximal limb of the ileum to optimize intestinal content drainage. Finally, the tunnel entrance of the gastrostomy was closed using nylon endoloops with the aid of a twin grasper. The gross and histopathological integrity of gastrostomy closure and the abdominal wall-ileum stoma tract formation were assessed 1 wk after the operation. RESULTS Transgastric endoscopic tube ileostomy was successful in all six pigs, without major bleeding. The mean operating time was 71 min (range: 60-110 min). There were no intraoperative complications or hemodynamic instability. The post-mortem, which was conducted 1-wk postoperatively, showed complete healing of the gastrostomy and adequate stoma tract formation of ileostomy. CONCLUSION Transgastric endoscopic tube ileostomy is technically feasible and reproducible in an animal model, and this technique is worthy of further improvement. PMID:27729743

  2. Surgical cartographic navigation system for endoscopic bypass grafting.

    PubMed

    Voruganti, Arun; Mayoral, Rafael; Jacobs, Stephan; Grunert, Ronny; Moeckel, Hendrik; Korb, Werner

    2007-01-01

    Endoscopic bypass grafting with the da Vinci system is still challenging and needs high level of experience and skill of the surgeon. Therefore, it is necessary to support the surgeon with enhanced vision and augmented reality. The augmentation of the patient model into the view of the endoscope is a direct approach to enhance support. The results of a preclinical study are shown in this paper. The method applied is suitable for endoscopic bypass grafting and in general applicable to minimal invasive surgery. The system was designed as an open architecture to facilitate easy transfer of the methodology into other surgical domain applications. PMID:18002243

  3. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    PubMed Central

    Calhan, Turan; Kahraman, Resul; Soydaş, Barış; Tosun, Ali; Cebeci, Egemen

    2015-01-01

    Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders. PMID:26697240

  4. Endoscopic and Abdominal Management of Complete Benign Esophageal Obstruction

    PubMed Central

    2016-01-01

    Benign esophageal strictures leading to complete esophageal occlusion are well known. In the pre-endoscopic era, such cases required surgery, but over the last decade, various novel endoscopic techniques have been developed to prevent morbidity and mortality. A 37-year-old man presented after 1 year of dysphagia and weight loss, and was found to have complete esophageal obstruction, not allowing even passage of guidewire. We used a combination antegrade endoscopic abdominal procedures to deploy a stent, obviating the need for surgery. His symptoms improved dramatically, and the stent was successfully removed 12 weeks later. He is now swallowing normally and has gained significant weight. PMID:27144192

  5. Endoscopic transoral and transmaxillary excision of the infratemporal fossa hemangioma.

    PubMed

    Nakaya, Muneo; Kida, Wataru; Ito, Akiko; Yoshihara, Shintaro; Fuchigami, Teruhiko

    2015-06-01

    Hemangiomas in the infratemporal fossa (ITF) are extremely rare benign vascular tumors. For many tumors of the ITF, with the exception of some small hemangiomas, a lateral facial approach has often been required. Recently, however, there have been some reports that minimally invasive endoscopic surgery can be used in the ITF; this would reduce the risk of surgical complications. To date, there has been no report of a hemangioma of the ITF exceeding 6 cm being resected by the endoscopic approach without facial incisions. Here, however, we report two cases of ITF hemangiomas that were completely extracted endoscopically, using a transmaxillary and transoral approach, without facial incisions or surgical complications.

  6. Endoscopic management of biliary leaks after laparoscopic cholecystectomy.

    PubMed

    Rustagi, Tarun; Aslanian, Harry R

    2014-09-01

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

  7. Endoscopic ultrasonography of duodenal aberrant pancreas: comparison with histology after endoscopic resection.

    PubMed

    Watanabe, Takashi; Aoyagi, Kunihiko; Tomioka, Yoshitaka; Ishibashi, Hideki; Nimura, Satoshi; Sakisaka, Shotaro

    2015-04-01

    We present the case of a 45-year-old man with an aberrant pancreas in the duodenum. He was referred to our hospital for gastric cancer screening. On upper gastrointestinal endoscopy, a submucosal tumor was noted in the second portion of the duodenum; it was 10 mm in diameter, with a smooth surface and bridging fold. Endoscopic ultrasonography (EUS) showed a hypoechoic lesion with small anechoic areas located in the third sonographic layer of the duodenum wall. To confirm the exact diagnosis, endoscopic resection was performed. The histological diagnosis was aberrant pancreas, Heinrich type II. The hypoechoic lesion and anechoic areas on EUS findings clearly corresponded with pancreatic acinus cells and duct dilation on histological findings, respectively. EUS findings are useful to diagnosis a duodenal aberrant pancreas that has ductal structures.

  8. Acquisition and Maintenance of Endoscopic Skills: Developing an endoscopic dexterity training system for anesthesiologists.

    PubMed

    Marsland, Colin P; Robinson, Brian J; Chitty, Chris H; Guy, Bernard J

    2003-01-01

    The acquisition and maintenance of essential psychomotor skills that are only required sporadically is a significant problem in medical training and practice. It is of particular relevance to anesthesiologists with regard to fibreoptic intubation, a technique that may be under-utilized despite its central role in the management of the difficult airway. Dexterity deficit due to current training models, dexterity decay due to lack of practice, and situational stress related to the clinical environment may combine to impede effective training and confident use of endoscopes in airway management. An educational resource (DexterÔ) has been developed to overcome these problems. Dexter is a non-anatomical, endoscopic dexterity training system designed to encourage practice and help establish and maintain a state of procedural readiness, even if clinical exposure to difficult airway situations is sporadic. PMID:27175419

  9. 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

  10. Complications associated with uni-portal endoscopic gastrocnemius recession in a diabetic patient population: an observational case series.

    PubMed

    Roukis, Thomas S; Schweinberger, Monica H

    2010-01-01

    The purpose of this article was to report the complications associated with uni-portal endoscopic gastrocnemius recession for surgical treatment of pathologic soft tissue ankle equinus contracture in diabetic patients. This is an observational case series involving a retrospective review of prospectively collected data of 23 uni-portal endoscopic gastrocnemius recessions used to treat pathologic soft tissue ankle equinus contracture in 18 consecutive diabetic patients between November 2006 and January 2009. Each patient underwent uni-portal endoscopic gastrocnemius recession under general or spinal anesthesia with thigh tourniquet control in combination with soft tissue and/or osseous reconstructive foot and/or ankle surgery. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 9 male and 9 female patients with a mean age +/- SD of 69.0 +/- 7.4-years (range: 47.0 to 71.0 years). There were 11 right and 12 left lower limbs involved, with 5 procedures performed bilateral. Complications included 3 conversions to an open incision secondary to difficulty dissecting through excessive adipose tissue, delayed healing of 3 incision sites in patients with uncontrolled diabetes mellitus at the time of surgery, and 3 undercorrections in patients with spastic contractures. The remainder of the procedures were deemed successful with no saphenous nerve, sural nerve, or lesser saphenous vein related injuries occurring. When properly performed, uni-portal endoscopic gastrocnemius recession represents a safe, reliable, and minimally invasive technique useful for correcting pathologic soft tissue ankle equinus contracture in patients with diabetes. A percutaneous tendo-Achilles lengthening should be performed in patients who have marginal arterial inflow that precludes tourniquet use or have a spastic contracture. An open rather than endoscopic gastrocnemius recession should be performed in

  11. Delayed traumatic diaphragmatic hernia

    PubMed Central

    Lu, Jing; Wang, Bo; Che, Xiangming; Li, Xuqi; Qiu, Guanglin; He, Shicai; Fan, Lin

    2016-01-01

    Abstract Background: Traumatic diaphragmatic hernias (TDHs) are sometimes difficult to identify at an early stage and can consequently result in diagnostic delays with life-threatening outcomes. It is the aim of this case study to highlight the difficulties encountered with the earlier detection of traumatic diaphragmatic hernias. Methods: Clinical data of patients who received treatment for delayed traumatic diaphragmatic hernias in registers of the First Affiliated Hospital of Xi’an Jiaotong University from 1998 to 2014 were analyzed retrospectively. Results: Six patients were included in this study. Left hemidiaphragm was affected in all of them. Most of the patients had a history of traffic accident and 1 a stab-penetrating injury. The interval from injury to developing symptoms ranged from 2 to 11 years (median 5 years). The hernial contents included the stomach, omentum, small intestine, and colon. Diaphragmatic injury was missed in all of them during the initial managements. All patients received operations once the diagnosis of delayed TDH was confirmed, and no postoperative mortality was detected. Conclusions: Delayed TDHs are not common, but can lead to serious consequences once occurred. Early detection of diaphragmatic injuries is crucial. Surgeons should maintain a high suspicion for injuries of the diaphragm in cases with abdominal or lower chest traumas, especially in the initial surgical explorations. We emphasize the need for radiographical follow-up to detect diaphragmatic injuries at an earlier stage. PMID:27512848

  12. Contingencies promote delay tolerance.

    PubMed

    Ghaemmaghami, Mahshid; Hanley, Gregory P; Jessel, Joshua

    2016-09-01

    The effectiveness of functional communication training as treatment for problem behavior depends on the extent to which treatment can be extended to typical environments that include unavoidable and unpredictable reinforcement delays. Time-based progressive delay (TBPD) often results in the loss of acquired communication responses and the resurgence of problem behavior, whereas contingency-based progressive delay (CBPD) appears to be effective for increasing tolerance for delayed reinforcement. No direct comparison of TBPD and CBPD has, however, been conducted. We used single-subject designs to compare the relative efficacy of TBPD and CBPD. Four individuals who engaged in problem behavior (e.g., aggression, vocal and motor disruptions, self-injury) participated. Results were consistent across all participants, and showed lower rates of problem behavior and collateral responses during CBPD than during TBPD. The generality of CBPD treatment effects, including optimal rates of communication and compliance with demands, was demonstrated across a small but heterogeneous group of participants, reinforcement contingencies, and contexts. PMID:27449401

  13. Endoscopic third ventriculostomy in post-tubercular meningitic hydrocephalus: a preliminary report.

    PubMed

    Singh, D; Sachdev, V; Singh, A K; Sinha, S

    2005-02-01

    Hydrocephalus is a common sequel of tubercular meningitis. Endoscopic third ventriculostomy (ETV) was performed in thirty-five patients. According to the duration of illness, six patients were in the early (less than 6 weeks), nineteen were in the intermediate (6 weeks to 6 months) and ten patients were in the late phase (more than 6 months) of tubercular meningitis (TBM). Six patients were in stage I, seven patients in stage II and twenty-two patients were in stage III. The overall success rate of ETV in TBM was 77 %. Sixty percent had early and seventeen percent had delayed recovery. Obstructive hydrocephalus was present in 54.3 % and 45.7 % had communicating hydrocephalus. The radiological recovery rate was 55.6 %. The outcome with a thin to transparent floor of the third ventricle was 87 %. PMID:15747217

  14. Endoscopic-CT: learning-based photometric reconstruction for endoscopic sinus surgery

    NASA Astrophysics Data System (ADS)

    Reiter, A.; Leonard, S.; Sinha, A.; Ishii, M.; Taylor, R. H.; Hager, G. D.

    2016-03-01

    In this work we present a method for dense reconstruction of anatomical structures using white light endoscopic imagery based on a learning process that estimates a mapping between light reflectance and surface geometry. Our method is unique in that few unrealistic assumptions are considered (i.e., we do not assume a Lambertian reflectance model nor do we assume a point light source) and we learn a model on a per-patient basis, thus increasing the accuracy and extensibility to different endoscopic sequences. The proposed method assumes accurate video-CT registration through a combination of Structure-from-Motion (SfM) and Trimmed-ICP, and then uses the registered 3D structure and motion to generate training data with which to learn a multivariate regression of observed pixel values to known 3D surface geometry. We demonstrate with a non-linear regression technique using a neural network towards estimating depth images and surface normal maps, resulting in high-resolution spatial 3D reconstructions to an average error of 0.53mm (on the low side, when anatomy matches the CT precisely) to 1.12mm (on the high side, when the presence of liquids causes scene geometry that is not present in the CT for evaluation). Our results are exhibited on patient data and validated with associated CT scans. In total, we processed 206 total endoscopic images from patient data, where each image yields approximately 1 million reconstructed 3D points per image.

  15. Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty

    PubMed Central

    Kanazawa, Ryo; Sai, Jin Kan; Ito, Tomoyasu; Miura, Hiroko; Ishii, Shigeto; Saito, Hiroaki; Tomishima, Ko; Shimizu, Ryo; Sato, Koki; Hayashi, Manabu; Watanabe, Sumio; Shiina, Shuichiro

    2016-01-01

    AIM To investigate the efficacy of prior minimal endoscopic sphincterotomy (EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty (EBS). METHODS After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST (up to one-third of the size the papilla) plus 8 mm EBS (EST-EBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control (control group). RESULTS One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was - 25.0 (217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5 (576.3) IU/L observed in the control group (P < 0.001). The incidence of post-procedure pancreatitis was 0% (0/105) in the EST-EBS group and 15.6% (5/32) in the control group (P < 0.001). CONCLUSION Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS. PMID:27803773

  16. Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis

    PubMed Central

    Akintoye, Emmanuel; Obaitan, Itegbemie; Muthusamy, Arunkumar; Akanbi, Olalekan; Olusunmade, Mayowa; Levine, Diane

    2016-01-01

    AIM To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD). METHODS We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ESD. RESULTS Twenty-nine thousand five hundred and six tumors in 27155 patients (31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90% (95%CI: 87%-92%) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in region (P = 0.02) and sample size (P = 0.04). Endoscopic en bloc and curative resection rates were 94% (95%CI: 93%-96%) and 86% (95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7% (95%CI: 2.1%-3.3%) and 0.39% (95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9% (95%CI: 1.3-6.6) and 3.6% (95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02% (95%CI: 0.001-1.4) among those with R0 resection and 7.7% (95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75% (95%CI: 0.42%-1.3%). CONCLUSION Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastric tumors and warrants consideration as first line therapy when an expert operator is available.

  17. Endoscopic submucosal dissection of gastric tumors: A systematic review and meta-analysis

    PubMed Central

    Akintoye, Emmanuel; Obaitan, Itegbemie; Muthusamy, Arunkumar; Akanbi, Olalekan; Olusunmade, Mayowa; Levine, Diane

    2016-01-01

    AIM To systematically review the medical literature in order to evaluate the safety and efficacy of gastric endoscopic submucosal dissection (ESD). METHODS We performed a comprehensive literature search of MEDLINE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of gastric ESD. RESULTS Twenty-nine thousand five hundred and six tumors in 27155 patients (31% female) who underwent gastric ESD between 1999 and 2014 were included in this study. R0 resection rate was 90% (95%CI: 87%-92%) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in region (P = 0.02) and sample size (P = 0.04). Endoscopic en bloc and curative resection rates were 94% (95%CI: 93%-96%) and 86% (95%CI: 83%-89%) respectively. The rate of immediate and delayed perforation rates were 2.7% (95%CI: 2.1%-3.3%) and 0.39% (95%CI: 0.06%-2.4%) respectively while rates of immediate and delayed major bleeding were 2.9% (95%CI: 1.3-6.6) and 3.6% (95%CI: 3.1%-4.3%). After an average follow-up of about 30 mo post-operative, the rate of tumor recurrence was 0.02% (95%CI: 0.001-1.4) among those with R0 resection and 7.7% (95%CI: 3.6%-16%) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 0.75% (95%CI: 0.42%-1.3%). CONCLUSION Our meta-analysis, the largest and most comprehensive assessment of gastric ESD till date, showed that gastric ESD is safe and effective for gastric tumors and warrants consideration as first line therapy when an expert operator is available. PMID:27606044

  18. [Endoscopic gallbladder stenting for acute cholecystitis].

    PubMed

    Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Oeholm, Masayuki; Harada, Masaru

    2014-12-01

    Acute cholecystitis is an inflammatory disease of the gallbladder. Inflammation often remains in the gallbladder, but some patients may take a fatal course with exacerbation of inflammation. Although laparoscopic cholecystectomy is recommended for moderate and severe acute cystitis, sometimes cholecystectomy is impossible in elder patients. Because many elder patients have bad general conditions, cholecystectomy should not be performed. Such patients are generally treated by percutaneous transhepatic gallbladder drainage (PTGBD), but PTGBD has the risk of intra-abdominal bleeding. In previous reports, endoscopic gallbladder stenting (EGBS) has been shown to be an effective strategy in cirrhosis patients with symptomatic cholelithiasis as a bridge to transplantation. Recent studies on EGBS have demonstrated an effective long-term management of acute cholecystitis in elderly patients who are poor surgical candidates. Here, we reviewed EGBS for the management of acute cholecystitis.

  19. Endoscopic management of complete colonic obstruction

    PubMed Central

    Schattner, Mark A; DiMaio, Christopher J; Gerdes, Hans; Wong, Douglas W; Markowitz, Arnold J

    2011-01-01

    A patient with metastatic rectal cancer underwent a diverting transverse loop colostomy due to rectal obstruction. 16 months later, he underwent a low anterior resection to resect his rectal cancer along with reversal of his transverse colostomy, and creation of a temporary loop ileostomy. Six months later, he was brought to the operating room for closure of his ileostomy. Post-operatively, the patient developed nausea, vomiting, and abdominal distention and imaging revealed a large bowel obstruction, confirmed by colonoscopy. The patient refused surgical diversion and a cecostomy tube was placed for decompression. After maturation of the cecostomy fistula, a rendezvous colonoscopy was performed, retrograde through the rectum and antegrade through the cecostomy fistula. The obstructing mucosa was traversed and the site of obstruction was balloon dilated, relieving the obstruction endoscopically. PMID:22586533

  20. Transanal endoscopic microsurgery: what indications in 2013?

    PubMed Central

    Morino, Mario; Allaix, Marco E.

    2013-01-01

    Thanks to major advances in the field of surgical techniques and neoadjuvant chemoradiation therapy, along with more accurate pre-operative staging tools and the widespread introduction of population-based screening programs, treatment of rectal cancer has been evolving over the past few decades, moving towards a more tailored approach. This has brought a shift in the treatment algorithm of benign rectal lesions and selected early rectal cancers, for which today transanal endoscopic microsurgery (TEM) is accepted as an effective alternative to abdominal surgery. In 2013, topics of controversy are the role of TEM in the treatment of more advanced rectal cancers, in cases of complete pathological response after chemoradiation therapy and the role of TEM as a platform for single-port surgery and NOTES. This article reviews the current indications for TEM and the future perspectives of this approach in the treatment of rectal tumors. PMID:24759812

  1. Infected Aneurysm after Endoscopic Submucosal Dissection.

    PubMed

    Gen, Shiko; Usui, Ryuichi; Sasaki, Takaya; Nobe, Kanako; Takahashi, Aya; Okudaira, Keisuke; Ikeda, Naofumi

    2016-01-01

    A 79-year-old man on hemodialysis was hospitalized for further investigation. Early gastric cancer was diagnosed by gastrointestinal endoscopy and endoscopic submucosal dissection (ESD) was performed. Fever and abdominal pain thereafter developed, and a severe inflammatory response was observed on a blood test. Contrast computed tomography (CT) showed ulcer-like projections and soft tissue surrounding the aorta, from the celiac to left renal artery. An infected aneurysm was diagnosed. Although infected aneurysms developing after laparoscopic cholecystectomy or biopsy of contiguous esophageal duplication cyst have been reported, those developing after ESD have not. When fever and abdominal pain develop after ESD, an infected aneurysm should be considered and contrast CT performed. PMID:27181541

  2. Outpatient experience with oesophageal endoscopic dilation.

    PubMed

    Jani, P G; Mburugu, P G

    1998-07-01

    Between March 1990 and August 1997, outpatient endoscopic balloon dilation was performed for oesophageal strictures which developed secondary to malignancies, peptic strictures, post surgical narrowing, achalasia cardia, corrosive ingestion and other causes. A total of 169 dilations were performed in the 92 cases with an average of 1.8 dilation/case (Range 1 to 8). Dilation was possible in all 92 cases without the need for fluoroscopic monitoring. Twenty three (13.6%) of the dilations were performed using pneumatic balloon while in 146(86.4%) cases wire guided metal olives were used. There were nine minor complications which were treated with medication on an outpatient basis and four major complications which required inpatient care. Three of these had perforation of the oesophagus and one died. One other patient developed aspiration pneumonia and subsequently died.

  3. [Endoscopic surgery for benign esophageal diseases].

    PubMed

    Ozawa, Soji

    2006-07-01

    Gastroesophageal reflux disease (GERD) and esophageal achalasia are common benign esophageal diseases. Today minimally invasive surgery is recommended to treat these diseases. Surgical indications for GERD are failure of medical management, medical complications attributable to a large hiatal hernia, 'atypical' symptoms (asthma, hoarseness, cough, chest pain, aspiration), etc. according to the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) guidelines. Laparoscopic Nissen fundoplication has emerged as the most widely accepted procedure for GERD patients with normal esophageal motility. Partial fundoplication (e.g., Toupet fundoplication) is also considered to decrease the possibility of postoperative dysphagia. Although pneumatic dilatation has been the first line treatment for esophageal achalasia, laparoscopic Heller myotomy and partial fundoplication (e.g., Dor fundoplication) to prevent reflux is preferred by most gastroenterologists and surgeons as the primary treatment modality. Laparoscopic surgery for GERD and esophageal achalasia are effective in most patients and safe in all patients. Finally, laparoscopic surgery should be performed only by skilled surgeons.

  4. What sedation to use during endoscopic procedure.

    PubMed

    Tonnarini, G F; Parlapiano, C; Pironti, E; Pantone, P; Chinazzi, A; Restuccia, M R; Antonaci, A

    2003-01-01

    Many endoscopists sometimes prefer to perform endoscopies without anaesthetic support, using only benzodiazepines. Endogenous opioid peptides are believed to play an important role in the modulation of pain within the endogenous analgesic system. A group of 40 patients undergoing diagnostic and therapeutic Endoscopic Retrograde Cholangiography and Pancreatography (ERCP) was recruited. Patients were divided into 2 groups according to Visual Analog Scale: pain 1-5 (Group A) and pain 6-10 (Group B). The beta-endorphin baseline values were significantly different between patients of Group A and Group B. Our data show that patients with levels of beta-endorphin over 8 pmol/L were less sensitive to pain, so that they become candidates for a traditional utilization of the benzodiazepines. However in the patients with beta-end levels less of 8 pmol/L should be suitable an anaesthetic as propofol because strong pain might provoke neurohumoral reflexes, cardiovascular alterations, and even a heart attack. PMID:15206488

  5. Endoscopic ultrasound-guided intravascular therapy.

    PubMed

    Binmoeller, Kenneth F; Sendino, Oriol; Kane, Steven D

    2015-01-01

    The gastrointestinal tract provides a unique "window" to access vascular structures in the mediastinum and abdomen. The advent of interventional endoscopic ultrasound (EUS) has enabled access to these structures with a standard fine-needle aspiration (FNA) needle. Sclerosants, cyanoacrylate, and coils can be delivered through the lumen of the FNA needle. EUS-guided treatment of gastric varices has theoretical advantages over conventional endoscopy-guided treatment. Controlled studies are needed to determine the role of EUS-guided treatment for primary and secondary prevention of variceal bleeding. There is a growing list of novel indications for EUS-guided vascular therapy that include portal vein angiography and pressure measurements, intrahepatic portosystemic shunt placement, and micro coil embolization of vascular structures. Additionally, access and therapy of the heart and surrounding structures appears feasible. PMID:25366271

  6. Endoscopic management of sigmoid volvulus in children

    PubMed Central

    Parolini, Filippo; Orizio, Paolo; Bulotta, Anna Lavinia; Garcia Magne, Miguel; Boroni, Giovanni; Cengia, Gianpaolo; Torri, Fabio; Alberti, Daniele

    2016-01-01

    Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means of sigmoidoscopy and concomitant rectal tube placement. The bowel is then prepared and surgery is undertaken electively during the same hospitalization. We report a detailed review of the literature focusing on technical details, risks and benefits of endoscopic management of SV in childhood. PMID:27358669

  7. Endoscopic ultrasound: Elastographic lymph node evaluation.

    PubMed

    Dietrich, Christoph F; Jenssen, Christian; Arcidiacono, Paolo G; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  8. Percutaneous endoscopic gastrostomy and early mortality.

    PubMed

    Clarkston, W K; Smith, O J; Walden, J M

    1990-12-01

    To assess morbidity, mortality, and benefit associated with percutaneous endoscopic gastronomy (PEG), we retrospectively studied 42 patients who had had PEG. Mortality was exceptionally high during the first 60 days after PEG (43%), and then stabilized. In nearly half of the cases (20/42) the PEG tube was removed during the first 60 days because of either death or improvement. Patients with malignancy had a significantly higher morbidity and 60-day mortality than the neurologically impaired. We concluded that patients should be carefully selected for PEG because early mortality is high; a 60-day trial of soft nasogastric feedings should be considered before PEG, and could reduce by nearly half the number of patients failing to receive long-term benefit; and patients with malignancy have significantly greater morbidity and mortality after PEG and may not receive the same advantage from the procedure.

  9. High speed receiver for capsule endoscope.

    PubMed

    Woo, S H; Yoon, K W; Moon, Y K; Lee, J H; Park, H J; Kim, T W; Choi, H C; Won, C H; Cho, J H

    2010-10-01

    In this study, a high-speed receiver for a capsule endoscope was proposed and implemented. The proposed receiver could receive 20 Mbps data that was sufficient to receive images with a higher resolution than conventional receivers. The receiver used a 1.2 GHz band to receive radio frequency (RF) signal, and demodulated the signal to an intermediate frequency (IF) stage (150 MHz). The demodulated signal was amplified, filtered, and under-sampled by a high-speed analog-to-digital converter (ADC). In order to decode the under-sampled data in real time, a simple frequency detection algorithm was selected and was implemented by using a FPGA. The implemented system could receive 20 Mbps data.

  10. Endoscopic submucosal dissection for colorectal neoplasms

    PubMed Central

    Takamaru, Hiroyuki; Mori, Genki; Yamada, Masayoshi; Kinjo, Yuzuru; So, Eriko; Abe, Seiichiro; Otake, Yosuke; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Yutaka

    2014-01-01

    Endoscopic submucosal dissection (ESD) is an established therapeutic technique for the treatment of gastrointestinal neoplasms. Because it is typically completed as en bloc resection, this technique provides a complete specimen for precise pathological evaluation. On the other hand, ESD is not as widely applied in treating colorectal neoplasms as with gastric cancers, due to its technical difficulty, longer procedure time, and increased risk of perforation. However, some devices that facilitate ESD and improve the safety of the procedure have been recently reported, and the use of the technique has gradually spread worldwide. Endoscopists who begin to perform ESD need to recognize the indications of ESD, the technical issue involved in this procedure, and its associated complications. This review outlines the methods and certain types of devices used for colorectal ESD. PMID:25333002

  11. Single incision endoscopic surgery for lumbar hernia.

    PubMed

    Kawaguchi, Masahiko; Ishikawa, Norihiko; Shimizu, Satsuki; Shin, Hisato; Matsunoki, Aika; Watanabe, Go

    2011-01-01

    Single Incision Endoscopic Surgery (SIES) has emerged as a less invasive surgery among laparoscopic surgeries, and this approach for incisional hernia was reported recently. This is the first report of SIES for an incisional lumbar hernia. A 66-year-old Japanese woman was referred to our institution because of a left flank hernia that developed after left iliac crest bone harvesting. A 20-mm incision was created on the left side of the umbilicus and all three trocars (12, 5, and 5 mm) were inserted into the incision. The hernial defect was 14 × 9 cm and was repaired with intraperitoneal onlay mesh and a prosthetic graft. The postoperative course was uneventful. SIES for lumbar hernia offers a safe and effective outcome equivalent compared to laparoscopic surgery. In addition, SIES is less invasive and has a cosmetic benefit.

  12. Endoscopic ultrasound: Elastographic lymph node evaluation

    PubMed Central

    Dietrich, Christoph F.; Jenssen, Christian; Arcidiacono, Paolo G.; Cui, Xin-Wu; Giovannini, Marc; Hocke, Michael; Iglesias-Garcia, Julio; Saftoiu, Adrian; Sun, Siyu; Chiorean, Liliana

    2015-01-01

    Different imaging techniques can bring different information which will contribute to the final diagnosis and further management of the patients. Even from the time of Hippocrates, palpation has been used in order to detect and characterize a body mass. The so-called virtual palpation has now become a reality due to elastography, which is a recently developed technique. Elastography has already been proving its added value as a complementary imaging method, helpful to better characterize and differentiate between benign and malignant masses. The current applications of elastography in lymph nodes (LNs) assessment by endoscopic ultrasonography will be further discussed in this paper, with a review of the literature and future perspectives. PMID:26374575

  13. Natural orifice translumenal endoscopic radical prostatectomy

    PubMed Central

    Castle, Erik P.; Andrews, Paul E.; Lingeman, James E.

    2012-01-01

    The purpose of this publication is to document the evolution of a new surgical procedure for the treatment of carefully selected patients with organ confined localized prostate cancer. Natural orifice surgery represents a paradigm shift in the surgical approach to disease, although its adoption into clinical practice has been limited to date. This manuscript describes the development of natural orifice translumenal endoscopic surgical radical prostatectomy (NOTES RP). The laboratory, animal, preclinical and early clinical experiences are described and detailed. While the early experiences with this approach are promising and encouraging, more information is required. Despite the early successes with the procedure, long-term oncological and functional outcomes are essential and more work needs to be done to facilitate the teaching and ease of the NOTES RP. PMID:22295043

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

    PubMed

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

    2014-01-01

    Per-oral endoscopic myotomy (POEM) is a new minimally invasive endoscopic treatment for achalasia. Since the first modern human cases were published in 2008, around 2,000 cases have been performed worldwide. This technique requires advanced endoscopic skills and a learning curve of at least 20 cases. POEM is highly successful with over 90 % improvement in dysphagia while offering patients the advantage of a low impact endoscopic access. The main long-term complication is gastroesophageal reflux (GER) with an estimated incidence of 35 %, similar to the incidence of GER post-laparoscopic Heller with fundoplication. Although POEM represents a paradigm shift in the treatment of achalasia, more long-term data are clearly needed to further define its role in the treatment algorithm of this rare disease. PMID:24362953

  15. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer

    PubMed Central

    Kim, Sang Gyun

    2016-01-01

    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period. PMID:27435699

  16. Endoscopic treatment of transnasal intracranial penetrating foreign body.

    PubMed

    Lee, Dong Hoon; Seo, Bo Ra; Lim, Sang Chul

    2011-09-01

    Transnasal intracranial penetrating injury is rare. We report a case of transnasal intracranial penetrating metallic chopstick, which was removed successfully by endoscopic approach, and management of transnasal intracranial penetrating injuries.

  17. 21 CFR 884.1660 - Transcervical endoscope (amnioscope) and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... visualize the fetus or amniotic fluid and to sample fetal blood or amniotic fluid. This generic type of...) Identification. A transcervical endoscope is a device designed to permit direct viewing of the fetus and...

  18. Endoscopic Ultrasound Guided Embolization of a Pancreatic Pseudoaneurysm

    PubMed Central

    Robb, Paul M.; Yeaton, Paul; Bishop, Thomas; Wessinger, John

    2012-01-01

    Pseudoaneurysms are rare complications of chronic pancreatitis and are associated with a high mortality. In this article we demonstrate a novel utilization of endoscopic ultrasound (EUS) technology to embolize a large pancreatic pseudoaneurysm when gold standard therapies had proven futile.

  19. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease.

    PubMed

    Lee, Ji Min; Lee, Kang-Moon

    2016-07-01

    Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet's disease (BD), which should be differentiated from Crohn's disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings. PMID:27484813

  20. Integration design of endoscopes with different viewing directions

    NASA Astrophysics Data System (ADS)

    Zhang, Lingyun; Cheng, Dewen; Wang, Yongtian

    2015-09-01

    High definition and magnification rigid endoscope is a significant equipment in the examination and surgery. In this paper, the design of a high definition (HD) rigid endoscope is presented with a FOV of 70°. The entrance pupil is 0.3 mm, achieved for the first time to our best knowledge. For the fabricated prototype, the theoretical resolution is 22.3 lp/mm at an object distance of 20 mm, the depth of field (DOF) is 115 mm and the stray light is eliminated effectively. The viewing angle of the developed endoscope is zero. However, the endoscope with non-zero viewing angle is more popular in some conditions, we present two designs with non-zero viewing direction for better observation and diagnosis of lesions on inner walls of organs and tissues.

  1. Treatment Strategy after Incomplete Endoscopic Resection of Early Gastric Cancer.

    PubMed

    Kim, Sang Gyun

    2016-07-01

    Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period. PMID:27435699

  2. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease

    PubMed Central

    Lee, Ji Min; Lee, Kang-Moon

    2016-01-01

    Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet’s disease (BD), which should be differentiated from Crohn’s disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings. PMID:27484813

  3. [Natural orifice transluminal endoscopic surgery: current situation].

    PubMed

    Delgado, Salvadora; Ibarzábal, Ainitze; Fernández-Esparrach, Glòria

    2008-10-01

    Natural orifice transluminal endoscopic surgery (NOTES) is the paradigm of the evolution of minimally invasive surgery. The laparoscopic has introduced new ideas in general surgery, one of them being that modern surgery is the work of multidisciplinary teams. A clear example of this is provided by NOTES. The aim of this type of surgery is to perform conventional laparoscopic procedures without incision, using flexible endoscopic technology usually employed in the diagnosis and treatment of intraluminal lesions and reaching the inside of the abdominal cavity through natural orifices (mouth, anus, vagina and even urethra). This type of access opens a highly interesting field for certain types of patients, such as those with high surgical risk, the morbidly obese, and those with multiple prior abdominal interventions or surgical wound infections. Animal models have shown that a wide variety of interventions (cholecystectomy, appendicectomy, splenectomy, hysterectomy, tubal ligations, gastroenteroanastomosis, peritoneoscopy, liver biopsy and herniorrhaphy, among others) can be performed. However, before use in humans, this new technique must be shown to be safe and to provide real advantages for patients. To do this, a series of issues, including safe methods for closure of the gastric incision and the avoidance of infections, among others, must be solved. Another critical element for the development of this new type of surgery is the creation of appropriate instrumentation, requiring input not only from medical professionals but also from engineers and industry. The present article describes the major advances made in NOTES since this technique was first described and analyzes the risks and potential benefits associated with this novel procedure.

  4. Endoscopic ultrasonic dacryocystorhinostomy: clinical profile and outcomes.

    PubMed

    Ali, Mohammad Javed; Singh, Manpreet; Chisty, Naja; Kamal, Saurabh; Naik, Milind N

    2016-07-01

    Ultrasonic endoscopic dacryocystorhinostomy (UEnDCR) is emerging alternative modality of managing nasolacrimal duct obstructions. The aim of this study was to report the clinical profile and outcomes with a UEnDCR with mitomycin C and silicone intubation. Prospective interventional case series performed on all consecutive patients undergoing an ultrasonic endoscopic dacryocystorhinostomy over a 1-year period from September 2013 to October 2014. All surgeries were performed by a single surgeon (MJA). Data collected include demographics, presentation, indications for surgery, past interventions, intraoperative and post-operative complications and outcomes. The main outcome measures were anatomical and functional success of the surgery. 44 procedures were performed in 41 patients. The mean age was 31.6 years. Children with complex congenital nasolacrimal duct obstructions refractory to probing and intubation accounted for 17 % (7/41) of the cohort. Past history of acute dacryocystitis was noted in 35.6 % (15/41). Two patients (4.9 %, 2/41) had failed external DCR. A minimal follow-up of 6 months following surgery was taken for final analysis. Complications included intraoperative focal epithelial burn in one patient that healed spontaneously and post-operative ostium granulomas in 15.9 % (7/44) of the ostia. At the 6-month follow-up, anatomical and functional successes were noted in 93.1 % (41/44) and 88.6 % (39/44), respectively. Ultrasonic dacryocystorhinostomy is a safe and effective alternative modality in the management of nasolacrimal duct obstructions in pediatric and adult age groups. Setup was easy and no additional technical difficulties were observed. PMID:26530294

  5. Endonasal endoscopic resection of juvenile nasopharyngeal angiofibroma.

    PubMed

    Eloy, Ph; Watelet, J B; Hatert, A S; de Wispelaere, J; Bertrand, B

    2007-03-01

    Juvenile angiofibroma (JNA) is a rare benign but locally aggressive tumour of the nasopharynx that primarily occurs in adolescent males. We report a series of 6 consecutive cases operated by exclusive endoscopic approach between from March 1996 and June 2003. All were male. The mean age was 17.2 years old (range: 11-23 years). The tumour involved the nasopharynx in all the cases (6/6), the sphenoid sinus (3/6) and the medial part of the pterygopalatine fossa (4/6). According to Radkowski's classification (Table 1), one patient was stage Ia, one was stage Ib and four patients were stage IIb. The mean duration of the surgery was 2 hours. The mean intraoperative blood loss was 575 ml despite a preoperative hyperselective embolization. The mean follow-up after the first operation was 67 months. All patients but one were free of disease. One patient had a recurrence in the nasopharynx and sphenoid sinuses requiring a successful revision procedure 3 years after the primary surgery. Another patient presented with a 5 mm non-symptomatic nodule in the pterygopalatine fossa, regressing on MRI during the 4 years following the surgery. In conclusion, endoscopic resection of JNA is a difficult but effective operation in experienced hands. Based upon the recent international literature, endonasal surgery combined with a preoperative embolization of the arterial supply is indicated for small and middle size JNAs but also for large tumours extended to the pterygopalatine fossa and medial aspect of the infratemporal fossa. Minimal intracranial extension is not an absolute contraindication if there is no clinical or radiological involvement of the cavernous sinus. A tridimentional guiding system can be of some help in large tumours.

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

    PubMed

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

    2013-06-01

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

  7. Effectiveness of Endoscopic Treatment for Gastrointestinal Neuroendocrine Tumors

    PubMed Central

    Sun, Weili; Wu, Siyuan; Han, Xiao; Yang, Chuanhua

    2016-01-01

    Abstract Several recent studies have explored efficacy and safety of different endoscopic treatments for gastrointestinal neuroendocrine tumors (GI-NETs). However, there is no definitive consensus regarding the best endoscopic approach for GI-NETs treatment. Therefore, the present study was conducted to investigate the application of various endoscopic techniques for the treatment of GI-NETs according to the previous conclusions and to summarize the optimal endoscopic modalities for GI-NETs. Ninety-eight patients with 100 GI-NETs removed by endoscopic therapies were reviewed. The pathological complete resection rate (PCRR), complication, local recurrence, and factors possibly associated with the pathological complete resection were analyzed. Twenty-two patients were treated by conventional polypectomy (including 6 cold biopsy forceps polypectomy and 16 snare polypectomy with electrocauterization), 41 by endoscopic mucosal resection (EMR), and 35 by endoscopic submucosal dissection (ESD). The PCRRs of conventional polypectomy, EMR, and ESD were 86.4%, 75.6%, and 85.7%, respectively. Sixteen GI-NETs that had a polypoid appearance, with a mean tumor size of 5.2 mm, were removed by snare polypectomy (PCRR 93.8%). The complication rates of conventional polypectomy, EMR, and ESD were 0.0% (0/22), 2.4% (1/41), and 2.9% (1/35), respectively. There were 2 local recurrences after cold biopsy forceps polypectomy treatment and no local recurrences in the EMR and ESD groups (P = 0.049). The results showed that PCRR was only associated with the depth of invasion (P = 0.038). Endoscopic resection of GI-NETs is safe and effective in properly selected patients. For submucosal GI-NETs, ESD was a feasible modality, with a higher PCRR compared with EMR. For ≤5 mm polypoid-like NETs, snare polypectomy with electrocauterization was a simple procedure with a high PCRR. PMID:27082572

  8. Endoscopic-assisted Correction of Hallux Valgus Deformity.

    PubMed

    Lui, Tun Hing; Ling, Samuel Ka Kin; Yuen, Simon Chi Pan

    2016-03-01

    Endoscopic distal soft-tissue procedure is one of the minimally invasive techniques for correction of the hallux valgus deformity. It employs the same principle as the open procedure. The intermetatarsal angle is corrected by screw and interosseous suture instead of first metatarsal osteotomy. The associated procedures of first metatarsal derotation, medial collateral ligament reconstruction, and arthroscopic Lapidus arthrodesis can tackle various problems faced during the endoscopic distal soft-tissue procedure. PMID:26752780

  9. ENDOSCOPIC DIAGNOSIS AND THERAPY IN GASTRO-ESOPAGEAL VARICEAL BLEEDING

    PubMed Central

    Sanyal, Arun J.

    2016-01-01

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

  10. Air embolism during endoscopic retrograde cholangiopancreatography in a pediatric patient.

    PubMed

    Di Pisa, M; Chiaramonte, G; Arcadipane, A; Burgio, G; Traina, M

    2011-01-01

    This is a case of a venous air embolism in a pediatric patient with splenomesenteric portal shunt for portal cavernoma, who underwent endoscopic retrograde cholangiopancreatography under inhalator general anesthesia, without using N2O. There is ample data in the literature about the occurrence of venous air embolism during an endoscopic procedure. We believe it is important to call attention to this rare, but possible, and sometimes fatal, complication.

  11. Extra flat, flexible and disposable endoscope for lateral imaging

    NASA Astrophysics Data System (ADS)

    Basset, G.; Marinov, D.; Hofer, C.; Cattaneo, S.; Volet, P.; Gallinet, B.; Schnieper, M.; Ferrini, R.

    2016-03-01

    We present an innovative disposable endoscope based on extra flat flexible polymer slabs used as multimode waveguides. The waveguides are compatible with low-cost roll-to-roll production technologies and can be easily customized by patterning, coating and printing techniques according to the specifications of the target application. In order to couple the light (i.e. the illumination beam and the imaging beam) in and out of the waveguide, diffractive subwavelength gratings are used. These nano-scale optical structures enable an efficient and controlled light trapping by total internal reflection, thus minimizing the distortion effects generated by the rough edges. Nano-patterning is obtained using established techniques (i.e. hot embossing and/or UV casting) that are compatible with industrial roll-to-roll production lines or plastic injection molding. Unique features of these innovative endoscopes are i) the achievable very thin form that can be reduced to thicknesses below 200 μm, ii) the ability to record lateral images with respect to the endoscope direction, iii) the ability to image samples (e.g. tissues, tiny objects) in direct contact with the polymer slab, with a minimum imaging distance equal to zero, and iv) the access to high volume fabrication techniques that can enable the production of low-cost disposable endoscopes. A possible device implementation is demonstrated and tested, which consists of a flat line-scanning endoscope enabling the acquisition of 1D images in monochromatic illumination and the reconstruction of 2D images by scanning. Images taken with such a disposable endoscope are discussed and the related technological constraints such as manufacturing tolerances, image distortion, scattered light and signal to noise ratio are further described. Finally, advantages and disadvantages with respect to other endoscopic techniques will be discussed, thus demonstrating the potential of this innovative approach for endoscopic applications in very

  12. Juvenile angiofibroma: case report and the role of endoscopic resection.

    PubMed

    Lim, I R; Pang, Y T; Soh, K

    2002-04-01

    Juvenile angiofibroma is benign yet aggressive. Due to its inaccessible location in the nasopharynx, open surgery usually requires osteotomies which cause stunting of facial growth in adolescent males. Advances in imaging and treatment techniques have now facilitated more accurate staging of this disease. For small, extracranial tumours limited to the nasal cavity and paranasal sinus, endoscopic resection is a viable alternative. This case report will illustrate how endoscopic resection allows good control with minimal morbidity compared to open surgery or radiotherapy.

  13. Endoscopic fenestration of a symptomatic cyst of the septum pellucidum.

    PubMed

    Vaquero, J; Manrique, M; De Prado, F

    2000-12-01

    We present the case of a 25-year-old woman suffering from chronic severe headaches and syncope associated with an expanding cyst of the septum pellucidum. After a simple endoscopic fenestration of the cyst the symptoms resolved, resulting in an excellent clinical outcome. This case shows that simple endoscopic fenestration may produce a rapid and maintained symptomatic improvement in patients with an expanding cyst of the septum pellucidum. PMID:11272036

  14. [Esophageal carcinoma after the endoscopic sclerotherapy of varices].

    PubMed

    Macías Rodríguez, M A; Soria de la Cruz, M J; Iglesias Arrabal, M; Martín Herrera, L

    1992-07-01

    We report the case of a 52-years-old smoking male, diagnosed of liver cirrhosis, who developed a squamous cell carcinoma of the esophagus 36 months after undergoing endoscopic injection sclerotherapy for bleeding esophageal varices. Nine courses with 3% polidocanol were performed along 10 months. It was injected intra and paravariceal at a total dose of 117 ml. The relationship between endoscopic injection sclerotherapy and developing squamous cell carcinoma of the esophagus is discussed.

  15. Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis

    PubMed Central

    Akintoye, Emmanuel; Kumar, Nitin; Aihara, Hiroyuki; Nas, Hala; Thompson, Christopher C.

    2016-01-01

    Background and study aims: Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal tumor. We systematically review the medical literature in order to evaluate the safety and efficacy of colorectal ESD. Patients and methods: We performed a comprehensive literature search of MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of colorectal ESD. Results: Included in this study were 13833 tumors in 13603 patients (42 % female) who underwent colorectal ESD between 1998 and 2014. The R0 resection rate was 83 % (95 % CI, 80 – 86 %) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in continent (P = 0.004), study design (P = 0.04), duration of the procedure (P = 0.009), and, marginally, by average tumor size (P = 0.09). Endoscopic en bloc and curative resection rates were 92 % (95 % CI, 90 – 94 %) and 86 % (95 % CI, 80 – 90 %), respectively. The rates of immediate and delayed perforation were 4.2 % (95 % CI, 3.5 – 5.0 %) and 0.22 % (95 % CI, 0.11 – 0.46 %), respectively, while rates of immediate and delayed major bleeding were 0.75 % (95 % CI, 0.31 – 1.8 %) and 2.1 % (95 % CI, 1.6 – 2.6 %). After an average postoperative follow up of 19 months, the rate of tumor recurrence was 0.04 % (95 % CI, 0.01 – 0.31) among those with R0 resection and 3.6 % (95 % CI, 1.4 – 8.8 %) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 1.0 % (95 % CI, 0.42 – 2.1 %). Conclusions: Our meta-analysis, the largest and most comprehensive assessment of colorectal ESD to date, showed that colorectal ESD is safe and effective for colorectal tumors and warrants consideration as first-line therapy when an expert operator is available. PMID

  16. [A case of chronic acalculous cholecystitis diagnosed by delayed contrast emptying in gallbladder].

    PubMed

    Kim, Chang Won; Lee, Jong Min; Coh, Jane; Jung, In Sung; Kang, Ki Man; Jung, Shin Hong; Lee, Gye Sung; Kim, Anna; Kwak, Seung Soo; Lee, Mi Sun

    2004-05-01

    Chronic acalculous cholecystitis is a diagnosis of exclusion in patients complaining acalculous biliary pain. The possible causes of acalculous biliary pain are chronic gallbladder (GB) inflammation, GB dysfunction, cholesterolosis, cystic duct stenosis or microlithiasis. Recently, laparoscopic cholecystectomy is the choice of treatment for acalculous biliary pain. We experienced a 32-year-old woman whose initial symptoms were right upper quadrant pain and nausea only. The abdominal computed tomography, DISIDA scan, and upper and lower endoscopic examinations were nonspecific. Up to 48 hours after endoscopic retrograde cholangiopancreatography, contrast emptying of GB was delayed, implying dysfunctional GB. As the patient's right upper quadrant pain and tenderness became aggravated, the laparoscopic cholecystectomy was done and the final diagnosis of chronic acalculous cholecystitis was confirmed. PMID:15156120

  17. Technical innovations and the evolution of endoscopic sinus surgery.

    PubMed

    Kennedy, David W

    2006-09-01

    Since the introduction of endoscopic sinus surgery, a number of significant technological advances, as well as an improved understanding of disease pathogenesis and management, have enabled major evolutions in surgical techniques. Modifications to surgical instruments, imaging, the development of the microdebrider, and other newer instrumentation have all contributed to the current level of patient success associated with endoscopic intranasal techniques. At the same time, it has become evident that anatomic variations are less important in the pathogenesis of chronic rhinosinusitis than was previously thought, and that ventilation alone is insufficient to resolve well-established disease. This paper reviews the changes that have occurred in endoscopic sinus surgery over the past 20 years since the techniques were first introduced into the United States, and the technologies that have enabled these changes and the development of extended endoscopic techniques. Continuing developments of interactive computer-guided surgery, endoscopic 3-dimensional imagery, robotics, and improved adjunctive therapies will further extend the role of endoscopic transnasal approaches to an expanded number of skull base and intracranial lesions. PMID:17040012

  18. Tissue acquisition in gastric epithelial tumor prior to endoscopic resection.

    PubMed

    Kim, Chan Gyoo

    2013-09-01

    Endoscopic forceps biopsy is essential before planning an endoscopic resection of upper gastrointestinal epithelial tumors. However, forceps biopsy is limited by its superficiality and frequency of sampling errors. Histologic discrepancies between endoscopic forceps biopsies and resected specimens are frequent. Factors associated with such histologic discrepancies are tumor size, macroscopic type, surface color, and the type of medical facility. Precise targeting of biopsies is recommended to achieve an accurate diagnosis, curative endoscopic resection, and a satisfactory oncologic outcome. Multiple deep forceps biopsies can induce mucosal ulceration in early gastric cancer. Endoscopic resection for early gastric cancer with ulcerative findings is associated with piecemeal resection, incomplete resection, and a risk for procedure-related complications such as bleeding and perforation. Such active ulcers caused by forceps biopsy and following submucosal fibrosis might also be mistaken as an indication for more aggressive procedures, such as gastrectomy with D2 lymph node dissection. Proton pump inhibitors might be prescribed to facilitate the healing of biopsy-induced ulcers if an active ulcer is predicted after deep biopsy. It is unknown which time interval from biopsy to endoscopic resection is appropriate for a safe procedure and a good oncologic outcome. Further investigations are needed to conclude the appropriate time interval.

  19. Hybrid natural orifice transluminal endoscopic surgery in gastric subepithelial tumors

    PubMed Central

    Heo, Jun; Jeon, Seong Woo

    2013-01-01

    Diagnosis of gastric subepithelial tumor (SET) has shown a rapid increase worldwide. Although, until now, endoscopic ultrasound guided procedures such as fine needle aspiration have shown relatively high accuracy in diagnosis of SET, the most important modality for diagnosis and treatment of SETs is complete resection such as endoscopic or surgical resection. However, endoscopic resection or laparoscopic wedge resection alone also has some limitations. Endoscopic resection is difficult to perform in cases of gastric SET located within deep portion of the gastric layer or a relatively large (larger than 25 mm diameter). On the other hand, gastric SET in a difficult location, such as the gastroesophageal junction or pyloric ring is challenging for laparoscopic surgical resection. The hybrid natural orifice transluminal endoscopic surgery (NOTES) technique is a combined method, including the advantages of both laparoscopic resection and endoscopic resection for gastric SETs. This method may be performed safely with reasonable operation times, less bleeding, and adequate resection margin and regardless of tumor size. In particular, in the case of a difficult location for resection, such as the esophagogastric junction or pyloric ring, hybrid NOTES is currently believed to be an ideal treatment method. PMID:24044041

  20. Endoscopic Suturing and Knot Tying: Theory Into Practice

    PubMed Central

    Murphy, Donald L.

    2001-01-01

    Objective To advance modern surgical techniques of endoscopic knot tying, encompassing a new appreciation of knot-tying theory and the application of second-generation, purpose-designed instruments. Summary Background Data During open surgery, surgeons automatically create the surgical half-hitch by using either instrument or hand/finger knot-tying methods (figure 4). Each of these methods, which are mirror images of each other, forms the same result, the half-hitch. Two opposing half-hitches are needed to form a square knot. There are many ways for new-generation instruments to create a secure square knot during endoscopic surgery. An overview of the current endoscopic knot-tying methods is presented. Methods The author presents a theoretical analysis of square knot-tying techniques as applied during instrument and hand/finger movements. The application of a mirror-image concept was considered in the analysis of these two contrasting methods. Results There are 12 ways to create a square knot, some of which have previously not been described or needed in open surgery. Some of these methods have particular application in endoscopic surgery. Conclusions A new understanding of knot-tying theory has been developed, with innovative methods being defined for tissue approximation during endoscopic surgery. These ergonomic, efficient, and contrasting methods of knot tying are described using second-generation endoscopic instruments. The new techniques have direct and broad application in many fields of minimally invasive surgery. PMID:11685022

  1. Endoscopic management of gastrointestinal perforations, leaks and fistulas

    PubMed Central

    Rogalski, Pawel; Daniluk, Jaroslaw; Baniukiewicz, Andrzej; Wroblewski, Eugeniusz; Dabrowski, Andrzej

    2015-01-01

    Gastrointestinal perforations, leaks and fistulas may be serious and life-threatening. The increasing number of endoscopic procedures with a high risk of perforation and the increasing incidence of leakage associated with bariatric operations call for a minimally invasive treatment for these complications. The therapeutic approach can vary greatly depending on the size, location, and timing of gastrointestinal wall defect recognition. Some asymptomatic patients can be treated conservatively, while patients with septic symptoms or cardio-pulmonary insufficiency may require intensive care and urgent surgical treatment. However, most gastrointestinal wall defects can be satisfactorily treated by endoscopy. Although the initial endoscopic closure rates of chronic fistulas is very high, the long-term results of these treatments remain a clinical problem. The efficacy of endoscopic therapy depends on several factors and the best mode of treatment will depend on a precise localization of the site, the extent of the leak and the endoscopic appearance of the lesion. Many endoscopic tools for effective closure of gastrointestinal wall defects are currently available. In this review, we summarized the basic principles of the management of acute iatrogenic perforations, as well as of postoperative leaks and chronic fistulas of the gastrointestinal tract. We also described the effectiveness of various endoscopic methods based on current research and our experience. PMID:26457014

  2. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy

    PubMed Central

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

    2016-01-01

    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac.

  3. Postoperative seizure following transforaminal percutaneous endoscopic lumbar discectomy

    PubMed Central

    Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

    2016-01-01

    Endoscopic surgery for lumbar disc herniation has been available for more than 30 years. Transforaminal percutaneous endoscopic lumbar discectomy is a well-known, safe, and effective method used for the treatment of the lumbar disc herniation. The published complications of the transforaminal percutaneous endoscopic lumbar discectomy consist of infections, thrombophlebitis, dysesthesia, dural tear, vascular injury, and death. Seizure after transforaminal percutaneous endoscopic lumbar discectomy is an extremely rare complication. A 20-year-old patient applied at our department who had undergone transforaminal percutaneous endoscopic lumbar. During the procedure, while performing the discography, non-ionic contrast media was administered into the thecal sac inadvertently. Two hours after surgery, the patient developed generalized tonic-clonic seizure of 5-min duration. Diagnosis of iohexol-induced seizure was made and the patient was treated supportively without anti-epileptics. Here we present the first case of seizure after transforaminal percutaneous endoscopic lumbar discectomy, which was caused by inadvertent administration of the contrast media into the thecal sac. PMID:27695562

  4. [Diagnosis of delayed puberty].

    PubMed

    Busiah, K; Belien, V; Dallot, N; Fila, M; Guilbert, J; Harroche, A; Leger, J

    2007-09-01

    Puberty is the phenomenon that conducts once to reproductive maturation. Delayed puberty (DP) is defined by the absence of testicular development in boys beyond 14 years old (or a testicular volume lower than 4 ml) and by the absence of breast development in girls beyond 13 years old. DP occurs in approximatively 3% of cases. Most cases are functional DP, with a large amount of constitutional delay of puberty. Others etiologies are hypogonadotrophic hypogonadism like Kallmann syndrome, or hypergonadotrophic hypogonadism. Turner syndrome is a diagnostic one should not forget by its frequency. Treatment is hormonal replacement therapy and of the etiology. During the last decade, many genes have been identified and elucidated the etiological diagnosis of some hypogonadotrophic hypogonadism syndrome. Further studies are required in collaboration with molecular biologists to better understand the mechanism of hypothalamic pituitary gonadal axis abnormalities and of the neuroendocrine physiology of the onset of puberty.

  5. Delayed coking process

    SciTech Connect

    Dabkowski, M.J.; Malladi, M.

    1987-04-28

    This patent describes a delayed cooking process in which a heavy oil coker feedstock is heated to an elevated coking temperature in a furnace and the heated feedstock is subsequently subjected to delayed coking in a coker drum under superatmospheric pressure and the vaporous coking products are removed from the drum and passed to a coker fractionator from which a bottoms fraction is removed. The improvement comprises coking a feed without the addition of the bottoms fraction from the fractionator and adding to the feed to the coker drum a lower boiling hydrocarbon diluent having an end boiling point of not more than 450/sup 0/C, the lower boiling hydrocarbon diluent being added to the heated feedstock after the feedstock has passed through the furnace.

  6. Delayed skin grafting.

    PubMed

    Ceilley, R I; Bumsted, R M; Panje, W R

    1983-04-01

    The use of skin grafts on granulating wounds is an established practice. Delaying the application of a full- or split-thickness skin graft may be an advantageous alternative method of surgical reconstruction in selected cases. Partial healing by secondary intention is useful for filling in deeper defects and usually produces a wound that is much smaller and of more normal contour than the original defect. Contraction of the graft bed is markedly influenced by location, tissue laxity, surface tension lines, motion, and wound geometry. Proper wound care, correct surgical preparation of the defect, and timing of the graft procedure are all important considerations in maximizing the overall result. Through-and-through defects and wounds produced over areas with little underlying support (eyelids and lip) often need flap reconstruction or immediate grafting to prevent undesirable functional and cosmetic results. By combining delayed healing and conventional reconstructive techniques, major tissue loss can often be restored while minimizing patient morbidity.

  7. Endoscopic characteristics and usefulness of endoscopic dilatation of anastomotic stricture following pancreaticojejunostomy: case series and a review of the literature

    PubMed Central

    Kida, Akihiko; Shirota, Yukihiro; Houdo, Yuji; Wakabayashi, Tokio

    2016-01-01

    The incidence of pancreatitis induced by anastomotic stricture following pancreaticodigestive tract anastomosis as a late-onset adverse event has been reported to be 3% or lower, but some cases repeatedly relapse and are difficult to treat. Endoscopic identification and treatment of the anastomotic site are considered to be difficult, and only a small number of cases have been reported. We present three cases with recurrent pancreatitis induced by anastomotic stricture following pancreaticojejunostomy applied after pancreaticoduodenectomy. We successfully identified the anastomotic site and performed endoscopic dilatation of the anastomotic stricture, and pancreatitis has not recurred. We characterized endoscopic features of the anastomotic site, understanding of which is essential to identify the site, and investigated useful techniques to identify the site and perform cannulation for pancreatography. Furthermore, we showed the safety and usefulness of endoscopic dilatation for anastomotic stricture following pancreaticojejunostomy according to our three cases and a review of the literature. PMID:27803744

  8. [Acromegaly: reducing diagnostic delay].

    PubMed

    Giustina, Andrea

    2016-08-01

    Diagnostic delay of acromegaly is still very relevant (6-8 years on average) without substantial changes in last twenty years. Clinical impact of this diagnostic delay is significant: tumor growth (2/3 of the patients at diagnosis bear a pituitary macroadenoma), development of irreversible complications (arthropathy, sleep apnea) and in all increased mortality. Reasons for this delay are related to the disease itself (facial and acral changes are very slow and subtle) but also to medical unawareness. Simple tools based on a few sufficiently sensitive and specific signs and symptoms which can trigger the diagnostic suspect would be useful in clinical practice. Global evaluation during follow-up (tumor volume, signs and symptoms, complications, circulating levels of growth hormone and its peripheral mediator IGF-I) has become crucial for the therapeutic decision making. In this regard, tools like SAGIT are now under validation and are expected to improve management of acromegaly. In fact, in the last 30 years there has been a relevant growth of the medical options to treat acromegaly and in the near future there will be an expansion of the medical options. This will greatly help the needed personalization of treatment which necessarily should consider patient convenience and preference and control of complications such as diabetes mellitus. PMID:27571562

  9. Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note.

    PubMed

    Felbaum, Daniel; Syed, Hasan R; Ryan, Joshua E; Jean, Walter C; Anaizi, Amjad

    2016-03-06

    Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal

  10. Assessing delay discounting in mice

    PubMed Central

    Mitchell, Suzanne H.

    2014-01-01

    Delay discounting (also intertemporal choice or impulsive choice) is the process by which delayed outcomes, such as delayed food delivery, are valued less than the same outcomes delivered immediately or with a shorter delay. This process is of interest because many psychopathologies, including substance dependence, pathological gambling, attention deficit hyperactivity disorder and conduct disorder, are characterized by heightened levels of delay discounting. Some of these disorders are heritable, and data indicate that delay discounting also has a genetic component. To identify the genes underlying the delay discounting decision-making process and genetic correlates of heightened discounting, researchers have used mouse models. This unit describes a protocol for generating delay discounting behavior in mice and discusses analysis techniques for such behavior. PMID:24510779

  11. Delayed Speech or Language Development

    MedlinePlus

    ... to Know About Zika & Pregnancy Delayed Speech or Language Development KidsHealth > For Parents > Delayed Speech or Language ... your child is right on schedule. Normal Speech & Language Development It's important to discuss early speech and ...

  12. Tooth formation - delayed or absent

    MedlinePlus

    Delayed or absent tooth formation; Teeth - delayed or absent formation ... The age at which a tooth comes in varies. Most infants get their first tooth between 6 and 9 months, but it may be earlier or later. ...

  13. Programmable Differential Delay Circuit With Fine Delay Adjustment

    DOEpatents

    DeRyckere, John F.; Jenkins, Philip Nord; Cornett, Frank Nolan

    2002-07-09

    Circuitry that provides additional delay to early arriving signals such that all data signals arrive at a receiving latch with same path delay. The delay of a forwarded clock reference is also controlled such that the capturing clock edge will be optimally positioned near quadrature (depending on latch setup/hold requirements). The circuitry continuously adapts to data and clock path delay changes and digital filtering of phase measurements reduce errors brought on by jittering data edges. The circuitry utilizes only the minimum amount of delay necessary to achieve objective thereby limiting any unintended jitter. Particularly, this programmable differential delay circuit with fine delay adjustment is designed to allow the skew between ASICS to be minimized. This includes skew between data bits, between data bits and clocks as well as minimizing the overall skew in a channel between ASICS.

  14. Delay Choice vs. Delay Maintenance: Different Measures of Delayed Gratification in Capuchin Monkeys (Cebus apella)

    PubMed Central

    Addessi, Elsa; Paglieri, Fabio; Beran, Michael J.; Evans, Theodore A.; Macchitella, Luigi; De Petrillo, Francesca; Focaroli, Valentina

    2013-01-01

    Delaying gratification involves two components: (i) delay choice (selecting a delayed reward over an immediate one), and (ii) delay maintenance (sustaining the decision to delay gratification even if the immediate reward is available during the delay). In primates, two tasks most commonly have explored these components, the Intertemporal choice task and the Accumulation task. It is unclear whether these tasks provide equivalent measures of delay of gratification. Here, we compared the performance of the same capuchin monkeys, belonging to two study populations, between these tasks. We found only limited evidence of a significant correlation in performance. Consequently, in contrast to what is often assumed, our data provide only partial support to the hypothesis that these tasks provide equivalent measures of delay of gratification. PMID:23544770

  15. New trend in endoscopic surgery: transvaginal appendectomy NOTES (Natural Orifice Transluminal Endoscopic Surgery).

    PubMed

    Tabutsadze, T; Kipshidze, N

    2009-03-01

    Natural Orifice Transluminal Endoscopic Surgery is a new method of mini invasive surgery, which involves passing surgical instruments, and a tiny camera, through a natural orifice, such as the mouth, vagina, urethra or rectum, what provides the access to the desired organ. The procedure is approved due to its benefits - less pain, quicker recoveries, fewer complications and no scar - as it lets us avoid major incisions through the skin, muscle and nerves of the abdomen. Besides that the transluminal access is considered to be the most safe and feasible for clinical application. Here are discussed the two operations of Transvaginal Appendectomy performed in Caucasus - Academician N. Kipshidze University Hospital in Tbilisi. The first patient - a 28-year woman, weight - 72 kg, height - 180 cm, married, has one child - was submitted to the hospital with anamnesis of 48 hours acute appendicitis, typical clinical semiotics and laboratory records. In the second case the patient was a 22-year old woman, height - 170 cm, weight - 68 kg, married, with 2 children. She was hospitalized with 24 hours acute appendicitis anamnesis and typical clinical semiotics and laboratory records. Both operations were performed under general anesthesia, using Karl Storz GmbH & Co. equipment. The duration of the first procedure was 76 minutes and the second operation lasted for 88 minutes. The operations were made without any technical difficulties or complications. None of the patients had the need of non-narcotic analgesia during the post-operational period. No gynecological or surgical problems or any complications were detected during the observation period. The patients had superior postoperative evolution, so the stationary stay made up 36 hours after the first operation and 30 hours after the second. Essentially NOTES is a new trend in endoscopic surgery - the non-scar surgery with major advantages compared to the conventional - the NOTES takes endoscopic surgery one step further in

  16. Adaptive Phase Delay Generator

    NASA Technical Reports Server (NTRS)

    Greer, Lawrence

    2013-01-01

    There are several experimental setups involving rotating machinery that require some form of synchronization. The adaptive phase delay generator (APDG) the Bencic-1000 is a flexible instrument that allows the user to generate pulses synchronized to the rising edge of a tachometer signal from any piece of rotating machinery. These synchronized pulses can vary by the delay angle, pulse width, number of pulses per period, number of skipped pulses, and total number of pulses. Due to the design of the pulse generator, any and all of these parameters can be changed independently, yielding an unparalleled level of versatility. There are two user interfaces to the APDG. The first is a LabVIEW program that has the advantage of displaying all of the pulse parameters and input signal data within one neatly organized window on the PC monitor. Furthermore, the LabVIEW interface plots the rpm of the two input signal channels in real time. The second user interface is a handheld portable device that goes anywhere a computer is not accessible. It consists of a liquid-crystal display and keypad, which enable the user to control the unit by scrolling through a host of command menus and parameter listings. The APDG combines all of the desired synchronization control into one unit. The experimenter can adjust the delay, pulse width, pulse count, number of skipped pulses, and produce a specified number of pulses per revolution. Each of these parameters can be changed independently, providing an unparalleled level of versatility when synchronizing hardware to a host of rotating machinery. The APDG allows experimenters to set up quickly and generate a host of synchronizing configurations using a simple user interface, which hopefully leads to faster results.

  17. Vehicle barrier with access delay

    DOEpatents

    Swahlan, David J; Wilke, Jason

    2013-09-03

    An access delay vehicle barrier for stopping unauthorized entry into secure areas by a vehicle ramming attack includes access delay features for preventing and/or delaying an adversary from defeating or compromising the barrier. A horizontally deployed barrier member can include an exterior steel casing, an interior steel reinforcing member and access delay members disposed within the casing and between the casing and the interior reinforcing member. Access delay members can include wooden structural lumber, concrete and/or polymeric members that in combination with the exterior casing and interior reinforcing member act cooperatively to impair an adversarial attach by thermal, mechanical and/or explosive tools.

  18. Delay reduction: current status.

    PubMed

    Fantino, E; Preston, R A; Dunn, R

    1993-07-01

    Delay-reduction theory states that the effectiveness of a stimulus as a conditioned reinforcer may be predicted most accurately by the reduction in time to primary reinforcement correlated with its onset. We review support for the theory and then discuss two new types of experiments that assess it. One compares models of choice in situations wherein the less preferred outcome is made more accessible; the other investigates whether frequency of conditioned reinforcement affects choice beyond the effect exerted by frequency of primary reinforcement.

  19. Three-Dimensional Hand-to-Gland Combat: The Future of Endoscopic Surgery?

    PubMed Central

    Nassimizadeh, A.; Muzaffar, S. J.; Nassimizadeh, M.; Beech, T.; Ahmed, S. K.

    2015-01-01

    Objective To compare two dimensional (2D), three-dimensional (3D) non–high-definition (HD), and 3D HD endoscopic surgical techniques. Methods We describe our initial operative experience with a novel 3D HD endoscopic endonasal approach involving a pituitary adenoma resection, provide a case series, and review the current literature. This is the first case in Europe using the new 3D HD endoscope. Results Although research evidence remains limited, there are no significant negative perioperative or postoperative outcomes when compared with 2D endoscopic techniques. In our experience the narrow operating corridors of endoscopic surgery cannot be addressed with 3D endoscopic techniques. The new 3D HD endoscope creates imaging quality similar to conventional 2D HD systems. Conclusion Three-dimensional endoscopic endonasal techniques provide an exciting new avenue, effectively addressing potential depth perception difficulties with current 2D systems. PMID:26623227

  20. Endoscopic Management of Gluteus Medius Tendon Tears.

    PubMed

    Thaunat, Mathieu; Noël, Eric; Nové-Josserand, Laurent; Murphy, Colin G; Sbiyaa, Mouhcine; Sonnery-Cottet, Bertrand

    2016-03-01

    Tears in the gluteus medius and minimus tendons have been recognized as an important cause of recalcitrant greater trochanteric pain syndrome. Because of the frequency of partial-thickness undersurface tears, this relatively unknown pathology is often misdiagnosed and left untreated. Surgery is indicated in case of 4 associated conditions: (i) Failure of conservative treatment with duration of symptoms >6 months; (ii) magnetic resonance imaging showing a tendon tear; (iii) positive ultrasound-guided infiltration test; and (iv) the absence of an evolved fatty degeneration or atrophy of the gluteus medius and minimus muscle. Endoscopic repair of partial or full-thickness tears, with systematic resection of the bony structures implicated in the impingement, and a complete bursectomy appear to give satisfactory results, although these results remain to be confirmed by clinical studies with longer follow-up. The degree of tendon degeneration may compromise the tissue left for reattachment, raising concerns over its healing capacity, durability, and ultimate strength of the repair. PMID:26752773

  1. Endoscopic Retroperitoneal Adrenalectomy for Adrenal Metastases

    PubMed Central

    Simutis, Gintaras; Lengvenis, Givi; Beiša, Virgilijus; Strupas, Kęstutis

    2014-01-01

    Objectives. To evaluate whether retroperitoneal approach for adrenalectomy is a safe and effective treatment for adrenal metastases (AM). Methods. From June 2004 to January 2014, nine consecutive patients with AM were treated with endoscopic retroperitoneal adrenalectomy (ERA). A retrospective study was conducted, and clinical data, tumor characteristics, and oncologic outcomes were acquired and analyzed. Results. Renal cancer was the primary site of malignancy in 44.4% of cases. The mean operative time was 132 ± 10.4 min. There were 5 synchronous and 4 metachronous AM. One patient required conversion to transperitoneal laparoscopic procedure. No mortality or perioperative complications were observed. The median overall survival was 11 months (range: 2–42 months). Survival rates of 50% and 25% were identified at 1 and 3 years, respectively. At the end of the study, 4 patients were alive with a mean observed follow-up of 20 months. No patients presented with local tumor relapse or port-site metastases. Conclusions. This study shows that ERA is a safe and effective procedure for resection of AM and advances the surgical treatment of adrenal disease. The use of the retroperitoneal approach for adrenal tumors less than 6 cm can provide very favorable surgical outcomes. PMID:25276132

  2. Endoscopic lithotripsy for bile duct stones.

    PubMed

    Lee, J G; Leung, J W

    1993-01-01

    Endoscopic sphincterotomy and common duct stone extraction is successful in 85-90% of patients using conventional balloons and baskets. However, most patients with biliary stones > 2 cm will require mechanical, electrohydraulic, or laser lithotripsy prior to stone extraction. Mechanical lithotripsy is inexpensive, easy to perform, and effective in 80-90% of cases. Most failures result from inability to entrap the stone in the lithotripsy basket. These cases may be successfully treated using either electrohydraulic or laser lithotripsy (intraductal shockwave lithotripsy). In most cases, intraductal shockwave lithotripsy requires direct visual control. Due to difficulty with peroral cholangioscopy, these techniques will not be widely used until a smaller, more maneuverable "mother and baby scope" system is developed. We recommend mechanical lithotripsy as the initial treatment for large biliary stones. Failed cases should be referred to specialized centers for a repeat attempt with intraductal shockwave lithotripsy. With this approach, an experienced endoscopist is successful in removing biliary stones in over 95% of patients. Long term biliary stenting remains a viable option for the high risk patients with large common bile duct stones.

  3. Applications of endoscopic ultrasound in pancreatic cancer

    PubMed Central

    Luz, Leticia Perondi; Al-Haddad, Mohammad Ali; Sey, Michael Sai Lai; DeWitt, John M

    2014-01-01

    Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging. PMID:24976719

  4. Applications of endoscopic ultrasound in pancreatic cancer.

    PubMed

    Luz, Leticia Perondi; Al-Haddad, Mohammad Ali; Sey, Michael Sai Lai; DeWitt, John M

    2014-06-28

    Since the introduction of endoscopic ultrasound guided fine-needle aspiration (EUS-FNA), EUS has assumed a growing role in the diagnosis and management of pancreatic ductal adenocarcinoma (PDAC). The objective of this review is to discuss the various applications of EUS and EUS-FNA in PDAC. Initially, its use for detection, diagnosis and staging will be described. EUS and EUS-FNA are highly accurate modalities for detection and diagnosis of PDAC, this high accuracy, however, is decreased in specific situations particularly in the presence of chronic pancreatitis. Novel techniques such as contrast-enhanced EUS, elastography and analysis of DNA markers such as k-ras mutation analysis in FNA samples are in progress and might improve the accuracy of EUS in the detection of PDAC in this setting and will be addressed. EUS and EUS-FNA have recently evolved from a diagnostic to a therapeutic technique in the management of PDAC. Significant developments in therapeutic EUS have occurred including advances in celiac plexus interventions with direct injection of ganglia and improved pain control, EUS-guided fiducial and brachytherapy seed placement, fine-needle injection of intra-tumoral agents and advances in EUS-guided biliary drainage. The future role of EUS and EUS in management of PDAC is still emerging.

  5. Clinical picture of peptic ulceration diagnosed endoscopically.

    PubMed Central

    Sheppard, M C; Holmes, G K; Cockel, R

    1977-01-01

    Clinical features and laboratory data are presented for 100 patients with benign gastric ulceration and 150 patients with duodenal ulceration confirmed endoscopically in a district general hospital unit. Abdominal pain was the commonest indication for endoscopy, but one third of examinations were performed for acute gastrointestinal haemorrhage. Although the patients were selected by referral for endoscopy their clinical presentation, age, and sex distribution were similar to those reported in previous general surveys. There were no clinical features which clearly distinguished gastric from duodenal ulceration. However, of those with gastric ulceration younger patients more often had distal ulcers and presented with pain, while elderly subjects tended to have high lesser curve involvement and presented with haemorrhage. Moreover, all females presenting with haemorrhage were aged over 50 years, while 6% of males bleeding from gastric ulceration and 40% of males bleeding from duodenal ulceration were under this age. Anaemia when present, except in two premenopausal females, indicated either a recent acute gastrointestinal haemorrhage or a coexistent second diagnosis. PMID:873333

  6. Endoscopic Optical Coherence Tomography in Urology

    NASA Astrophysics Data System (ADS)

    Pan, Yingtian; Waltzer, Wayne; Ye, Zhangqun

    Clinical statistics has shown a stable prevalence of bladder cancer in recent years, which by far remains among the most common types of malignancy in the USA. With smoking as the most well-established risk factor, bladder cancer is the fourth most common cancer occurrences in male population [1]. In the year of 2014, an estimated 74,690 new cases are expected to occur with estimated 15,580 deaths. Bladder cancer often refers to transitional cell carcinoma (TCC) as it originates primarily from the epithelial cell layer (i.e., urothelium) of the bladder. Unlike prostate-specific antigen (PSA) for prostate cancer screening, there is currently no effective screening technique approved or recommended for the population at average risk [2-5]. As a result, hematuria (i.e., blood in the urine) is often the first clinical symptom of bladder cancer. Fortunately, urinary bladder is more accessible than prostate glands endoscopically; thus cytology following white-light cystoscopy has been the gold standard for current clinical detection of bladder cancer. This is important because bladder cancer if diagnosed prior to muscle invasion (e.g., superficial or at

  7. Endoscopic vein harvesting: technique, outcomes, concerns & controversies

    PubMed Central

    Sarang, Zubair

    2013-01-01

    The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short- and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH. PMID:24251019

  8. Sedation for Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    2016-01-01

    Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery. PMID:27738652

  9. Epidemiology of delayed ejaculation

    PubMed Central

    Di Sante, Stefania; Mollaioli, Daniele; Gravina, Giovanni Luca; Ciocca, Giacomo; Limoncin, Erika; Carosa, Eleonora; Lenzi, Andrea

    2016-01-01

    A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency. PMID:27652226

  10. Delayed rule following

    PubMed Central

    Schmitt, David R.

    2001-01-01

    Although the elements of a fully stated rule (discriminative stimulus [SD], some behavior, and a consequence) can occur nearly contemporaneously with the statement of the rule, there is often a delay between the rule statement and the SD. The effects of this delay on rule following have not been studied in behavior analysis, but they have been investigated in rule-like settings in the areas of prospective memory (remembering to do something in the future) and goal pursuit. Discriminative events for some behavior can be event based (a specific setting stimulus) or time based. The latter are more demanding with respect to intention following and show age-related deficits. Studies suggest that the specificity with which the components of a rule (termed intention) are stated has a substantial effect on intention following, with more detailed specifications increasing following. Reminders of an intention, too, are most effective when they refer specifically to both the behavior and its occasion. Covert review and written notes are two effective strategies for remembering everyday intentions, but people who use notes appear not to be able to switch quickly to covert review. By focusing on aspects of the setting and rule structure, research on prospective memory and goal pursuit expands the agenda for a more complete explanation of rule effects. PMID:22478363

  11. Epidemiology of delayed ejaculation

    PubMed Central

    Di Sante, Stefania; Mollaioli, Daniele; Gravina, Giovanni Luca; Ciocca, Giacomo; Limoncin, Erika; Carosa, Eleonora; Lenzi, Andrea

    2016-01-01

    A large body of literature on diminished ejaculatory disorders has been generated without the use of a clear diagnostic definition. Many studies have not distinguished between the orgasm and ejaculation disorders leading to doubtful results. Delayed ejaculation (DE) is one of the diminished ejaculatory disorders, which range from varying delays in ejaculatory latency to a complete inability to ejaculate. The present review is aimed at providing a comprehensive overview of the current knowledge on the definition and epidemiology of diminished ejaculatory disorders. We focus on the acquired diseases, such as benign prostatic hyperplasia (BPH) and specific drug regimens that may cause an iatrogenic form of ejaculatory disorder. In addition, the impact of aging is discussed since the prevalence of DE appears to be moderately but positively related to age. Finally, we also focus on the importance of the hormonal milieu on male ejaculation. To date, evidence on the endocrine control of ejaculation is derived from small clinical trials, but the evidence suggests that hormones modulate the ejaculatory process by altering its overall latency.

  12. Factors affecting surgical outcome of endoscopic third ventriculostomy in congenital hydrocephalus.

    PubMed

    Bisht, Ajay; Suri, Ashish; Bansal, Sumit; Chandra, P Sarat; Kumar, Rajinder; Singh, Manmohan; Sharma, Bhawani Shankar

    2014-09-01

    Endoscopic third ventriculostomy (ETV) is an accepted modality of treatment for obstructive hydrocephalus, with good results in adult patients. However in the pediatric age group results vary from poor to similar to the adult population. This study evaluates the outcome of ETV in congenital hydrocephalus of both early and delayed presentation, and investigates factors that determine the outcome. Patients with congenital hydrocephalus who underwent ETV between January 2006 and December 2011 were retrospectively analyzed. Any conditions potentially influencing the need for redo surgery (persistent cerebrospinal fluid [CSF] leak not responding to local measures, tense fontanelle, increased ventricular size, recurrence of symptoms or radiological evidence of failure) were analyzed. A total of 102 patients with a mean age of 7.45years were included. Presenting features were increasing head circumference and delayed milestones. Ninety-eight patients had triventricular hydrocephalus due to aqueductal stenosis. Procedures performed were ETV only (n=74), ETV with aqueductoplasty (n=22), ETV with cystoventriculostomy (n=2) and aqueductoplasty only (n=2). Failure of ETV occurred in 11 patients and all were managed with a ventriculoperitoneal shunt. CSF leak in the perioperative period was the only factor that was significantly associated with failure of ETV. ETV is a safe procedure with a good success rate and can be offered to children with aqueductal stenosis. There is a higher chance of failure if there is a CSF leak in the early or late postoperative period.

  13. A high definition Mueller polarimetric endoscope for tissue characterisation.

    PubMed

    Qi, Ji; Elson, Daniel S

    2016-05-12

    The contrast mechanism of medical endoscopy is mainly based on metrics of optical intensity and wavelength. As another fundamental property of light, polarization can not only reveal tissue scattering and absorption information from a different perspective, but can also provide insight into directional tissue birefringence properties to monitor pathological changes in collagen and elastin. Here we demonstrate a low cost wide field high definition Mueller polarimetric endoscope with minimal alterations to a rigid endoscope. We show that this novel endoscopic imaging modality is able to provide a number of image contrast mechanisms besides traditional unpolarized radiation intensity, including linear depolarization, circular depolarization, cross-polarization, directional birefringence and dichroism. This enhances tissue features of interest, and additionally reveals tissue micro-structure and composition, which is of central importance for tissue diagnosis and image guidance for surgery. The potential applications of the Mueller polarimetric endoscope include wide field early epithelial cancer diagnosis, surgical margin detection and energy-based tissue fusion monitoring, and could further benefit a wide range of endoscopic investigations through intra-operative guidance.

  14. Advances in the endoscopic management of pancreatic collections

    PubMed Central

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

    2015-01-01

    Treatment of pancreatic collections has experienced great progress in recent years with the emergence of alternative minimally invasive techniques comparing to the classic surgical treatment. Such techniques have been shown to improve outcomes of morbidity vs surgical treatment. The recent emergence of endoscopic drainage is noteworthy. The advent of endoscopic ultrasonography has been crucial for treatment of these specific lesions. They can be characterized, their relationships with neighboring structures can be evaluated and the drainage guided by this technique has been clearly improved compared with the conventional endoscopic drainage. Computed tomography is the technique of choice to characterize the recently published new classification of pancreatic collections. For this reason, the radiologist’s role establishing and classifying in a rigorously manner the collections according to the new nomenclature is essential to making therapeutic decisions. Ideal scenario for comprehensive treatment of these collections would be those centers with endoscopic ultrasound and interventional radiology expertise together with hepatobiliopancreatic surgery. This review describes the different types of pancreatic collections: acute peripancreatic fluid collection, pancreatic pseudocysts, acute necrotic collection and walled-off necrosis; the indications and the contraindications for endoscopic drainage, the drainage technique and their outcomes. The integrated management of pancreatic collections according to their type and evolution time is discussed. PMID:25901217

  15. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes

    PubMed Central

    Yue, James J.; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection. PMID:26114086

  16. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    PubMed

    Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures. PMID:25534058

  17. Benefits and harms of endoscopic screening for gastric cancer.

    PubMed

    Hamashima, Chisato

    2016-07-28

    Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use. PMID:27605874

  18. Endoscopic submucosal dissection for colorectal neoplasms: A review

    PubMed Central

    Sakamoto, Taku; Mori, Genki; Yamada, Masayoshi; Kinjo, Yuzuru; So, Eriko; Abe, Seiichiro; Otake, Yosuke; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Yutaka

    2014-01-01

    The introduction of colorectal endoscopic submucosal dissection (ESD) has expanded the application of endoscopic treatment, which can be used for lesions with a low metastatic potential regardless of their size. ESD has the advantage of achieving en bloc resection with a lower local recurrence rate compared with that of piecemeal endoscopic mucosal resection. Moreover, in the past, surgery was indicated in patients with large lesions spreading to almost the entire circumference of the rectum, regardless of the depth of invasion, as endoscopic resection of these lesions was technically difficult. Therefore, a prime benefit of ESD is significant improvement in the quality of life for patients who have large rectal lesions. On the other hand, ESD is not as widely applied in the treatment of colorectal neoplasms as it is in gastric cancers owing to the associated technical difficulty, longer procedural duration, and increased risk of perforation. To diversify the available endoscopic treatment strategies for superficial colorectal neoplasms, endoscopists performing ESD need to recognize its indications, the technical issues involved in its application, and the associated complications. This review outlines the methods and type of devices used for colorectal ESD, and the training required by endoscopists to perform this procedure. PMID:25473168

  19. Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection

    PubMed Central

    Lee, Sun-Young

    2016-01-01

    Endoscopic findings of the background gastric mucosa are important in the Helicobacter pylori-seroprevalent population. It is strongly correlated not only with the risk of gastric cancer, but also with the excretion ability of gastric mucosa cells. In noninfected subjects, common endoscopic findings are regular arrangement of collecting venules, chronic superficial gastritis, and erosive gastritis. In cases of active H. pylori infection, nodularity on the antrum, hemorrhagic spots on the fundus, and thickened gastric folds are common endoscopic findings. The secreting ability of the gastric mucosa cells is usually intact in both noninfected and actively infected stomachs, and the intragastric condition becomes hyperacidic upon inflammation. Increased serum pepsinogen II concentration correlates well with active H. pylori infection, and also indicates an increased risk of diffuse-type gastric cancer. In chronic inactive H. pylori infection, metaplastic gastritis and atrophic gastritis extending from the antrum (closed-type chronic atrophic gastritis) toward the corpus (open-type chronic atrophic gastritis) are common endoscopic findings. The intragastric environment is hypoacidic and the risk of intestinal-type gastric cancer is increased in such conditions. Furthermore, there is a decrease in serum pepsinogen I concentration when the secreting ability of the gastric mucosa cells is damaged. Serologic and endoscopic changes that occur upon H. pylori infection are important findings for estimating the secreting ability of the gastric mucosa cells, and could be applied for the secondary prevention of gastric cancer. PMID:27604795

  20. Benefits and harms of endoscopic screening for gastric cancer

    PubMed Central

    Hamashima, Chisato

    2016-01-01

    Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.

  1. Benefits and harms of endoscopic screening for gastric cancer

    PubMed Central

    Hamashima, Chisato

    2016-01-01

    Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use. PMID:27605874

  2. A high definition Mueller polarimetric endoscope for tissue characterisation.

    PubMed

    Qi, Ji; Elson, Daniel S

    2016-01-01

    The contrast mechanism of medical endoscopy is mainly based on metrics of optical intensity and wavelength. As another fundamental property of light, polarization can not only reveal tissue scattering and absorption information from a different perspective, but can also provide insight into directional tissue birefringence properties to monitor pathological changes in collagen and elastin. Here we demonstrate a low cost wide field high definition Mueller polarimetric endoscope with minimal alterations to a rigid endoscope. We show that this novel endoscopic imaging modality is able to provide a number of image contrast mechanisms besides traditional unpolarized radiation intensity, including linear depolarization, circular depolarization, cross-polarization, directional birefringence and dichroism. This enhances tissue features of interest, and additionally reveals tissue micro-structure and composition, which is of central importance for tissue diagnosis and image guidance for surgery. The potential applications of the Mueller polarimetric endoscope include wide field early epithelial cancer diagnosis, surgical margin detection and energy-based tissue fusion monitoring, and could further benefit a wide range of endoscopic investigations through intra-operative guidance. PMID:27173145

  3. Endoscopic gastritis, serum pepsinogen assay, and Helicobacter pylori infection.

    PubMed

    Lee, Sun-Young

    2016-09-01

    Endoscopic findings of the background gastric mucosa are important in the Helicobacter pylori-seroprevalent population. It is strongly correlated not only with the risk of gastric cancer, but also with the excretion ability of gastric mucosa cells. In noninfected subjects, common endoscopic findings are regular arrangement of collecting venules, chronic superficial gastritis, and erosive gastritis. In cases of active H. pylori infection, nodularity on the antrum, hemorrhagic spots on the fundus, and thickened gastric folds are common endoscopic findings. The secreting ability of the gastric mucosa cells is usually intact in both noninfected and actively infected stomachs, and the intragastric condition becomes hyperacidic upon inflammation. Increased serum pepsinogen II concentration correlates well with active H. pylori infection, and also indicates an increased risk of diffuse-type gastric cancer. In chronic inactive H. pylori infection, metaplastic gastritis and atrophic gastritis extending from the antrum (closed-type chronic atrophic gastritis) toward the corpus (open-type chronic atrophic gastritis) are common endoscopic findings. The intragastric environment is hypoacidic and the risk of intestinal-type gastric cancer is increased in such conditions. Furthermore, there is a decrease in serum pepsinogen I concentration when the secreting ability of the gastric mucosa cells is damaged. Serologic and endoscopic changes that occur upon H. pylori infection are important findings for estimating the secreting ability of the gastric mucosa cells, and could be applied for the secondary prevention of gastric cancer. PMID:27604795

  4. A high definition Mueller polarimetric endoscope for tissue characterisation

    NASA Astrophysics Data System (ADS)

    Qi, Ji; Elson, Daniel S.

    2016-05-01

    The contrast mechanism of medical endoscopy is mainly based on metrics of optical intensity and wavelength. As another fundamental property of light, polarization can not only reveal tissue scattering and absorption information from a different perspective, but can also provide insight into directional tissue birefringence properties to monitor pathological changes in collagen and elastin. Here we demonstrate a low cost wide field high definition Mueller polarimetric endoscope with minimal alterations to a rigid endoscope. We show that this novel endoscopic imaging modality is able to provide a number of image contrast mechanisms besides traditional unpolarized radiation intensity, including linear depolarization, circular depolarization, cross-polarization, directional birefringence and dichroism. This enhances tissue features of interest, and additionally reveals tissue micro-structure and composition, which is of central importance for tissue diagnosis and image guidance for surgery. The potential applications of the Mueller polarimetric endoscope include wide field early epithelial cancer diagnosis, surgical margin detection and energy-based tissue fusion monitoring, and could further benefit a wide range of endoscopic investigations through intra-operative guidance.

  5. Evaluation of a compound eye type tactile endoscope

    NASA Astrophysics Data System (ADS)

    Yoshimoto, Kayo; Yamada, Kenji; Sasaki, Nagisa; Takeda, Maki; Shimizu, Sachiko; Nagakura, Toshiaki; Takahashi, Hideya; Ohno, Yuko

    2013-03-01

    Minimally invasive surgical techniques for endoscope become widely used, for example, laparoscopic operation, NOTES (Natural Orifice Translumenal Endoscopic Surgery), robotic surgery and so on. There are so many demand and needs for endoscopic diagnosis. Especially, palpation is most important diagnosis on any surgery. However, conventional endoscopic system has no tactile sensibility. There are many studies about tactile sensor for medical application. These sensors can measure object at a point. It is necessary to sense in areas for palpation. To overcome this problem, we propose compound eye type tactile endoscope. The proposed system consists of TOMBO (Thin Observation Module by Bound Optics) and clear silicon rubber. Our proposed system can estimate hardness of target object by measuring deformation of a projected pattern on the silicon rubber. The purpose of this study is to evaluate the proposed system. At first, we introduce approximated models of the silicone and the object. We formulate the stiffness of object, the deformation of silicone, and the whole object. We investigate the accuracy of measured silicone's lower surface for deformation of silicone by prototype system. Finally, we evaluate the calculated stiffness of the soft object.

  6. Endoscopic papillectomy: The limits of the indication, technique and results

    PubMed Central

    Ardengh, José Celso; Kemp, Rafael; Lima-Filho, Éder Rios; dos Santos, José Sebastião

    2015-01-01

    In the majority of cases, duodenal papillary tumors are adenomas or adenocarcinomas, but the endoscopy biopsy shows low accuracy to make the correct differentiation. Endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography are important tools for the diagnosis, staging and management of ampullary lesions. Although the endoscopic papillectomy (EP) represent higher risk endoscopic interventions, it has successfully replaced surgical treatment for benign or malignant papillary tumors. The authors review the epidemiology and discuss the current evidence for the use of endoscopic procedures for resection, the selection of the patient and the preventive maneuvers that can minimize the probability of persistent or recurrent lesions and to avoid complications after the procedure. The accurate staging of ampullary tumors is important for selecting patients to EP or surgical treatment. Compared to surgery, EP is associated with lower morbidity and mortality, and seems to be a preferable modality of treatment for small benign ampullary tumors with no intraductal extension. The EP procedure, when performed by an experienced endoscopist, leads to successful eradication in up to 85% of patients with ampullary adenomas. EP is a safe and effective therapy and should be established as the first-line therapy for ampullary adenomas. PMID:26265992

  7. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes.

    PubMed

    Yue, James J; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection. PMID:26114086

  8. Percutaneous Endoscopic Gastrostomy: Mortality and Risk Factors for Survival

    PubMed Central

    Onder, Akin; Kapan, Murat; Arikanoglu, Zulfu; Gul, Mesut; Bestas, Remzi; Palanci, Yilmaz; Karaman, Haktan; Bac, Bilsel

    2012-01-01

    Background The present study evaluated long-term risk factors for survival in patients who have undergone Percutaneous endoscopic Gastrostomy, as well as morbidity and mortality rates. Methods The retrospective study included 44 patients who underwent placement of a percutaneous endoscopic gastrostomy tube at various departments at Dicle University Medical Faculty between April 2008-September 2010. Results The study evaluated 23 women (52.3%) and 21 men (47.7%), with a median age of 50 ± 20 (17 - 87) years. Median time for Percutaneous endoscopic Gastrostomy placement was 23 ± 8.3 (5 - 45) minutes per patient. Total morbidity was 15.9%, including wound infection (4), tube occlusion (1), peristomal leakage (1), and abdominal wall bleeding (1). Short-term complications were not associated with albumin level (P = 0.312).The median hospital stay was 49.34 ± 60.99 (1 - 314) days. The mean follow-up period was 13.07 ± 13.12 (1 - 41) months. The above-normal level of albumin was found to be effective on survival (P = 0.024). Mortality occurred in 18 (40.9%) patients during the follow-up. Conclusions Percutaneous endoscopic Gastrostomy is both safe and effective in that it does not require surgical operation and it can be performed under surface anesthesia. The serum albumin level with patients who have undergone percutaneous endoscopic gastrostomyis an effective factor for survival.

  9. A high definition Mueller polarimetric endoscope for tissue characterisation

    PubMed Central

    Qi, Ji; Elson, Daniel S.

    2016-01-01

    The contrast mechanism of medical endoscopy is mainly based on metrics of optical intensity and wavelength. As another fundamental property of light, polarization can not only reveal tissue scattering and absorption information from a different perspective, but can also provide insight into directional tissue birefringence properties to monitor pathological changes in collagen and elastin. Here we demonstrate a low cost wide field high definition Mueller polarimetric endoscope with minimal alterations to a rigid endoscope. We show that this novel endoscopic imaging modality is able to provide a number of image contrast mechanisms besides traditional unpolarized radiation intensity, including linear depolarization, circular depolarization, cross-polarization, directional birefringence and dichroism. This enhances tissue features of interest, and additionally reveals tissue micro-structure and composition, which is of central importance for tissue diagnosis and image guidance for surgery. The potential applications of the Mueller polarimetric endoscope include wide field early epithelial cancer diagnosis, surgical margin detection and energy-based tissue fusion monitoring, and could further benefit a wide range of endoscopic investigations through intra-operative guidance. PMID:27173145

  10. Total Endoscopic Thyroidectomy with Intraoperative Laryngeal Nerve Monitoring

    PubMed Central

    Lv, Bin; Zhang, Bin; Zeng, Qing-Dong

    2016-01-01

    Objective. To evaluate the clinical efficacy of laryngeal nerve (LN) monitoring (LNM) during total endoscopic thyroidectomy via breast approach, with emphasis on the identification rates for RLN and EBSLN and the incidence of RLN paralysis. Materials and Methods. This retrospective study included 280 patients who underwent endoscopic thyroidectomy with or without LNM. RLN and EBSLN were identified using endoscopic magnification in the control group, while they were localized additionally by LNM in the LNM group. Demographic parameters and surgical outcomes were analyzed by statistical methods. Patients in the control group were also stratified by the side of thyroidectomy to determine difference in left and right RLN injury rates. Results. All procedures were successfully conducted without permanent LN damage. The identification rates for RLN and EBSLN were high in the LNM group compared to those of the control group, and the risk difference (RD) of temporary RLN injury between two groups was 6.3%. The risk of damage was slightly higher for the left RLN than for the right RLN in the control group, which was performed by a right-hand surgeon. Conclusion. The joint application of LNM and endoscopic magnified view endows total endoscopic thyroidectomy with ease, safety, and efficiency. PMID:27413372

  11. 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

  12. [Endoscopic therapy for cancer of the esophagogastric junction].

    PubMed

    Fujisaki, Junko; Omae, Masami; Shimizu, Tomoki; Morishige, Kenjiro; Miyamoto, Yuji; Taniguchi, Chika; Horiuchi, Yusuke; Yoshio, Toshiyuki; Ishiyama, Akiyoshi; Hirasawa, Toshiaki; Yamamoto, Yorimasa; Tsuchida, Tomohiro; Igarashi, Masahiro

    2015-01-01

    In Japan, the criteria for cancer of the esophagogastric junction (EGJ) are that the center of the lesions are located within 2cm from the EGJ orally and anally. The main histology of these lesions are squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma of the esophagus is treated following the guidelines published by the Japan Esophageal Society. This paper focuses on EGJ adenocarcinomas, which include cardiac gastric cancer and Barrett's cancer originating from the short-segment Barrett's esophagus. EGJ cancer is resected endoscopically at the termination of the palisade vessels or upper end of the gastric fold. The various types of cancer involving the EGJ are treated following the guidelines published by each medical specialist society in Japan. The main endoscopic treatment is endoscopic submucosal dissection. The EGJ is a narrow space, and therefore lesions are approached from the oral approach or anal approach using a reverse endoscope. Bleeding, perforation, and stenosis are major complications. When two-thirds or more of the wall is resected, stenosis occurs. Endoscopic therapy for cancer originating in the EGJ has not yet been fully established. PMID:25842810

  13. Design of the new rigid endoscope distortion measurement system

    NASA Astrophysics Data System (ADS)

    Zhai, Xiaohao; Liu, Xiaohua; Liu, Ming; Hui, Mei; Dong, Liquan; Zhao, Yuejin; Wang, Yakun; Li, Yonghui; Zhou, Peng

    2015-08-01

    Endoscopic imaging quality affects industrial safety and medical security. Rigid endoscope distortion is of great signification as one of optical parameters to evaluate the imaging quality. This paper introduces a new method of rigid endoscope distortion measurement, which is different from the common methods with low accuracy and fussy operation. It contains a Liquid Crystal Display (LCD) to display the target, a CCD to obtain the images with distortion, and a computer to process the images. The LCD is employed instead of common white screen. The autonomous control system of LCD makes it showing the test target designed for distortion, and its parameter is known. LCD control system can change the test target to satisfy the different demand for accuracy, which avoids replacing target frequently. The test system also contains a CCD to acquire images in the exit pupil position of rigid endoscope. Rigid endoscope distortion is regarded as centrosymmetric, and the MATLAB software automatically measures it by processing the images from CCD. The MATLAB software compares target images with that without distortion on LCD and calculates the results. Relative distortion is obtained at different field of view (FOV) radius. The computer plots the curve of relative distortion, abscissa means radius of FOV, ordinate means relative distortion. The industry standard shows that, the distortion at 70% field of view is pointed on the curve, which can be taken as an evaluation standard. This new measuring method achieves advantages of high precision, high degree of intelligence, excellent repeatability and gets calculation results quickly.

  14. Congenital duodenal web: successful management with endoscopic dilatation

    PubMed Central

    Poddar, Ujjal; Jain, Vikas; Yachha, Surender Kumar; Srivastava, Anshu

    2016-01-01

    Background and study aims: Congenital duodenal web (CDW) is an uncommon cause of duodenal obstruction and endoscopic balloon dilatation has been reported in just eight pediatric cases to date. Here we are reporting three cases of CDW managed successfully with balloon dilatation. Cases and methods: In 2014 we diagnosed three cases of CDW on the basis of typical radiological and endoscopic findings. Endoscopic balloon dilatation was done under conscious sedation with a through-the-scope controlled radial expansion (CRE) balloon. Results: All three children presented late (median age 8 [range 2 – 9] years) with bilious vomiting, upper abdominal distension, and failure to thrive. One of them had associated Down syndrome and another had horseshoe kidney. In all cases, CDW was observed in the second part of the duodenum beyond the ampulla, causing partial duodenal obstruction. After repeated endoscopic dilatation (2 – 4 sessions), all three patients became asymptomatic. None of the patients experienced complications after balloon dilatation. Conclusions: Duodenal diaphragm should be suspected in patients with abdominal distension with bilious vomiting, even in relatively older children. Endoscopic balloon dilatation is a simple and effective method of treating this condition. PMID:27004237

  15. Stability and delay sensitivity of neutral fractional-delay systems.

    PubMed

    Xu, Qi; Shi, Min; Wang, Zaihua

    2016-08-01

    This paper generalizes the stability test method via integral estimation for integer-order neutral time-delay systems to neutral fractional-delay systems. The key step in stability test is the calculation of the number of unstable characteristic roots that is described by a definite integral over an interval from zero to a sufficient large upper limit. Algorithms for correctly estimating the upper limits of the integral are given in two concise ways, parameter dependent or independent. A special feature of the proposed method is that it judges the stability of fractional-delay systems simply by using rough integral estimation. Meanwhile, the paper shows that for some neutral fractional-delay systems, the stability is extremely sensitive to the change of time delays. Examples are given for demonstrating the proposed method as well as the delay sensitivity.

  16. Stability and delay sensitivity of neutral fractional-delay systems

    NASA Astrophysics Data System (ADS)

    Xu, Qi; Shi, Min; Wang, Zaihua

    2016-08-01

    This paper generalizes the stability test method via integral estimation for integer-order neutral time-delay systems to neutral fractional-delay systems. The key step in stability test is the calculation of the number of unstable characteristic roots that is described by a definite integral over an interval from zero to a sufficient large upper limit. Algorithms for correctly estimating the upper limits of the integral are given in two concise ways, parameter dependent or independent. A special feature of the proposed method is that it judges the stability of fractional-delay systems simply by using rough integral estimation. Meanwhile, the paper shows that for some neutral fractional-delay systems, the stability is extremely sensitive to the change of time delays. Examples are given for demonstrating the proposed method as well as the delay sensitivity.

  17. Stability and delay sensitivity of neutral fractional-delay systems.

    PubMed

    Xu, Qi; Shi, Min; Wang, Zaihua

    2016-08-01

    This paper generalizes the stability test method via integral estimation for integer-order neutral time-delay systems to neutral fractional-delay systems. The key step in stability test is the calculation of the number of unstable characteristic roots that is described by a definite integral over an interval from zero to a sufficient large upper limit. Algorithms for correctly estimating the upper limits of the integral are given in two concise ways, parameter dependent or independent. A special feature of the proposed method is that it judges the stability of fractional-delay systems simply by using rough integral estimation. Meanwhile, the paper shows that for some neutral fractional-delay systems, the stability is extremely sensitive to the change of time delays. Examples are given for demonstrating the proposed method as well as the delay sensitivity. PMID:27586618

  18. Do the adjusting-delay and increasing-delay tasks measure the same construct: delay discounting?

    PubMed

    Craig, Andrew R; Maxfield, Adam D; Stein, Jeffrey S; Renda, C Renee; Madden, Gregory J

    2014-08-01

    Delay discounting describes the subjective devaluation of a reward when it is delayed. In animals, the adjusting-delay (AD) and increasing-delay (ID) tasks often are used to assess individual differences in, and drug effects on, delay discounting. No study to date, however, has compared systematically the measures of discounting produced in these tasks. The current study examined the correlation between measures of delay discounting derived from AD and ID procedures. Twenty rats completed 30 sessions under each task (order counterbalanced across rats). Quantitative measures of delay discounting produced by the two tasks were positively correlated, suggesting that the AD and ID tasks measure the same underlying facet of impulsive choice (i.e. individual or conjoint sensitivities to reward delay and magnitude). The measures derived from either task, however, depended on the sequences in which the tasks were experienced. That is, pre-exposure to one task decreased discounting of delayed rewards in the second task. Consistent with other published findings, exposure to delayed consequences during the initial discounting assessment might explain this effect. Despite the observed correlation between ID and AD indifference delays, we suggest that the ID procedure might be a more appropriate procedure for pharmacological studies.

  19. The Use of Channel-Purge Storage for Gastrointestinal Endoscopes Reduces Microbial Contamination.

    PubMed

    Saliou, Philippe; Cholet, Franck; Jézéquel, Julien; Robaszkiewicz, Michel; Le Bars, Hervé; Baron, Raoul

    2015-09-01

    Storage cabinets for heat-sensitive endoscopes (SCHEs) are designed to store gastrointestinal (GI) endoscopes in a clean, dry and well-ventilated cupboard to prevent microbiological proliferation. The use of SCHEs in a GI endoscopy unit has significally reduced the rate of contaminated endoscopes (13.0% vs 45.0%, P<.001). PMID:26036960

  20. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)

    PubMed Central

    Schnell, Dan; Krzeski, Piotr; Abreu, Maria T; Altman, Douglas G; Colombel, Jean-Frédéric; Feagan, Brian G; Hanauer, Stephen B; Lémann, Marc; Lichtenstein, Gary R; Marteau, Phillippe R; Reinisch, Walter; Sands, Bruce E; Yacyshyn, Bruce R; Bernhardt, Christian A; Mary, Jean-Yves; Sandborn, William J

    2011-01-01

    Background Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). Objective To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. Design A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0–11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0–100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. Results There was 76% agreement for ‘severe’, but 27% agreement for ‘normal’ appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR2, Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). Conclusion The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall

  1. Soviet delays raise prices

    SciTech Connect

    Young, I.

    1992-01-15

    The breakup of the Soviet Union is causing massive disruptions to methanol exports. The changeover to a Commonwealth of independent States has created logistical problems which have led some shipments of Russian methanol to be cancelled and delayed other deliveries by up to two weeks. In recent years the Soviet Union has exported 700,000 m.t./year-900,000 m.t./year of methanol, mainly to Western Europe. The product is made at 750,000-m.t./year plants at Tomsk and Gubakha in Russia and transported by rail for shipment from the ports of Ventspils, Latvia, on the Baltic Sea and Yuzhnyy in Ukraine, on the Black Sea. The exports were handled by state export agency Soyuzagrochim, mainly under contract to West European traders and consumers in areas like Scandinavia and France.

  2. Delayed cure bismaleimide resins

    DOEpatents

    Adams, Johnnie E.; Jamieson, Donald R.

    1984-08-07

    Polybismaleimides prepared by delayed curing of bis-imides having the formula ##STR1## wherein R.sub.1 and R.sub.2 each independently is H, C.sub.1-4 -alkyl, C.sub.1-4 -alkoxy, Cl or Br, or R.sub.1 and R.sub.2 together form a fused 6-membered hydrocarbon aromatic ring, with the proviso that R.sub.1 and R.sub.2 are not t-butyl or t-butoxy; X is O, S or Se; n is 1-3; and the --(CH.sub.2).sub.n -- group, optionally, is substituted by 1-3 methyl groups or by fluorine.

  3. Natural orifice transesophageal endoscopic surgery: state of the art.

    PubMed

    Moreira-Pinto, João; Ferreira, Aníbal; Rolanda, Carla; Correia-Pinto, Jorge

    2012-01-01

    The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome. PMID:22567228

  4. Natural Orifice Transesophageal Endoscopic Surgery: State of the Art

    PubMed Central

    Moreira-Pinto, João; Ferreira, Aníbal; Rolanda, Carla; Correia-Pinto, Jorge

    2012-01-01

    The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome. PMID:22567228

  5. ENDOSCOPIC REMOVAL OF A GIANT ETHMOID OSTEOMA WITH ORBITAL EXTENSION

    PubMed Central

    Muderris, Togay; Bercin, Sami; Sevil, Ergun; Kiris, Muzaffer

    2012-01-01

    Osteomas are slow growing bony tumours of the paranasal sinuses. They are usually asymptomatic but they may present with headache, cerebral symptoms, or visual disturbances, depending on their anotomical location. A computerized tomography scan is the imaging modality that should be choosen for the diagnosis of osteomas. Radiographically, osteoid osteoma appears as an opaque lesion with a nidus which has a radioluscent center surrounded by dense sclerosis. If treatment is indicated, external or endoscopic approaches can be chosen. We report a rare case of giant ethmoido-orbital osteoma which was treated via endoscopic approach. The endoscopic way is convenient and safe enough with advantages over the external approach. The decreased morbidity and better cosmetic results are clear advantages of this technique which has the potential to become the treatment of choice for selected ethmoid tumours, such as a giant tumour mentioned in this study. PMID:23378698

  6. Endoscopic-assisted epiphysiodesis: technique and 20-year experience.

    PubMed

    Ledesma, Justin B; Wang, Tianyi; Desmond, Elizabeth; Imrie, Meghan; Gamble, James G; Rinsky, Lawrence A

    2016-01-01

    The aim of the study was to describe the endoscopic-assisted epiphysiodesis technique and review our 20-year experience with it. A retrospective review of 44 patients who underwent proximal tibia and/or distal femur endoscopic-assisted epiphysiodesis was carried out. Only patients who had preoperative and postoperative scanograms with clinical follow-up of at least 6 months were included. The mean length of follow-up was 36.8 months. All patients had radiographic evidence of physeal fusion within 6-12 months from the index procedure. No patient required revision surgery. Endoscopic-assisted epiphysiodesis is safe, effective, and achieves predictable physeal fusion. Advantages over current techniques include reduced radiation exposure and lack of requirement for hardware placement.

  7. Endoscopic Pubic Symphysectomy for Athletic Osteitis Pubis.

    PubMed

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

    2015-06-01

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

  8. [Extracorporeal shockwave therapy in endoscopic therapy-refractory gallstones].

    PubMed

    Tudyka, J; Wechsler, J G; Kratzer, W; Janowitz, P; Stange, E F; Adler, G

    1992-12-22

    Extracorporeal shock-wave lithotripsy (ESWL) was undertaken in 36 patients (12 men, 24 women; mean age 70.9 +/- 2.4 years) with extra- or intrahepatic bile duct stones which could not be removed endoscopically. Stone fragmentation was successful in 32 patients with stones in the choledochal duct and in one with stones in the left hepatic duct. Fragmentation failed in two patients with stones in the left hepatic duct and one with stones in the cystic duct. 26 of the 36 patients were free of stone after spontaneous passage (n = 3) or after endoscopic removal of the residual concrements (n = 23). Complications occurred in only five patients during or after ESWL (cardiac arrhythmias, respiratory failure, pancreatitis, cholangitis).--These data point to ESWL being clearly preferable to surgical intervention in bile duct stones refractory to endoscopic treatment, especially in the elderly with an increased perioperative risk.

  9. Primary Malignant Melanoma of the Esophagus With Unusual Endoscopic Findings

    PubMed Central

    Liu, Hui; Yan, Yan; Jiang, Chun-Meng

    2016-01-01

    Abstract Primary malignant melanoma of the esophagus (PMME) is a rare disease with an extremely poor prognosis. We experienced a 79-year-old man with PMME who had unusual endoscopic findings. On endoscopy, an elongated lump was detected on 1 side of the vertical axis of the esophagus. The mass extended progressively for 15 cm along the esophageal longitudinal axis and invaded half of the esophageal circumference. These endoscopic findings were not characteristic of PMME, and the condition was confirmed with biopsy and immunohistochemical staining. Here, we present this rare case and review the recent relevant literature regarding PMME. Doctors should be aware that PMME might present with unusual endoscopic findings. PMID:27124046

  10. Endoscopic Therapy of Early Carcinoma of the Oesophagus

    PubMed Central

    Knabe, Mate; May, Andrea; Ell, Christian

    2015-01-01

    Summary Background Oesophageal cancer is a comparatively rare disease in the Western world. Prognosis is highly dependent on the choice of treatment. Early stages can be treated by endoscopic resection, whereas surgery needs to be performed in the case of advanced carcinomas. Technical progress has enabled high-definition endoscopes and technical add-ons which help the endoscopist in finding fine irregularities in the oesophageal mucosa, though interpretation still remains challenging. Methods In this review, we discuss both novel and old diagnostic procedures and their value, as well as the current recommendations for the diagnosis and treatment of early oesophageal carcinomas. The database of PubMed and Medline was searched and analysed to provide all relevant literature for this review. Results and Conclusion Endoscopic resection is the therapy of choice in early oesophageal cancer. In case of adenocarcinoma it is mandatory to perform subsequent ablation of all residual Barrett's mucosa to avoid metachronous lesions. PMID:26989386

  11. Advanced gastrointestinal endoscopic imaging for inflammatory bowel diseases

    PubMed Central

    Tontini, Gian Eugenio; Rath, Timo; Neumann, Helmut

    2016-01-01

    Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn’s disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection. PMID:26811662

  12. Novel endoscopic imaging system for early cancer diagnosis

    NASA Astrophysics Data System (ADS)

    Igarashi, Makoto; Gono, Kazuhiro

    2007-02-01

    We have developed the novel video endoscope imaging techniques; Narrow band imaging (NBI), Auto-Fluorescence Imaging (AFI), Infra-Red Imaging (IRI) and Endo-Cytoscopy System (ECS). The purpose of these imaging techniques is to emphasize the important tissue features associated with early stage of lesions. We have already launched the new medical endoscope system including NBI, AFI and IRI (EVIS LUCERA SPECTRUM, OLYMPUS MEDICAL SYSTEMS Co., Ltd., Fig.1). Moreover ECS, which has enough magnification to observe cell nuclei on a superficial mucosa under methylene blue dye staining, is the endoscopic instrument with ultra-high optical zoom. In this paper we demonstrate the concepts and the medical efficacy of each technology.

  13. New devices and techniques for endoscopic closure of gastrointestinal perforations

    PubMed Central

    Li, Yue; Wu, Jian-Hua; Meng, Yan; Zhang, Qiang; Gong, Wei; Liu, Si-De

    2016-01-01

    Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.

  14. Management of simultaneous biliary and duodenal obstruction: the endoscopic perspective.

    PubMed

    Baron, Todd H

    2010-09-01

    Obstructive jaundice often develops in patients with unresectable malignancy in and around the head of the pancreas. Duodenal obstruction can also occur in these patients, and usually develops late in the disease course. Palliation of both malignant biliary and duodenal obstruction is traditionally performed with surgical diversion of the bile duct and stomach, respectively. With the advent of nonsurgical palliation of biliary obstruction using endoscopic transpapillary expandable metal stent placement, a similar approach can be used to palliate duodenal obstruction by placement of expandable metal gastroduodenal stents. Endoscopic palliation can be achieved in patients who require relief of both biliary obstruction and duodenal obstruction, although this can be technically difficult to achieve depending on the level of duodenal obstruction in relation to the major papilla. This article reviews the endoscopic approaches for combined palliative relief of malignant biliary and duodenal obstruction.

  15. New devices and techniques for endoscopic closure of gastrointestinal perforations

    PubMed Central

    Li, Yue; Wu, Jian-Hua; Meng, Yan; Zhang, Qiang; Gong, Wei; Liu, Si-De

    2016-01-01

    Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences. PMID:27672268

  16. New devices and techniques for endoscopic closure of gastrointestinal perforations.

    PubMed

    Li, Yue; Wu, Jian-Hua; Meng, Yan; Zhang, Qiang; Gong, Wei; Liu, Si-De

    2016-09-01

    Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences. PMID:27672268

  17. Endoscopic Repair of the Superficial Deltoid Ligament and Spring Ligament.

    PubMed

    Lui, Tun Hing

    2016-06-01

    The plantar calcaneonavicular ligament, also known as the spring ligament, is an important static stabilizer of the medial longitudinal foot arch. Compromise of this ligament is a primary causative factor of peritalar subluxation, and it should be repaired in addition to treatment of tibialis posterior tendon abnormalities. Open repair of the ligament requires extensive soft-tissue dissection. The development of the high distal portal for posterior tibial tendoscopy allows repair of the ligament endoscopically. This, together with endoscopically assisted reconstruction of the tibialis posterior tendon, allows complete endoscopic treatment of stage 2 posterior tibial tendon deficiency. The major structure at risk is the medial plantar nerve. This technique is technically demanding and should be reserved for experienced foot and ankle arthroscopists. PMID:27656387

  18. Compact endoscopic fluorescence detection system for gastrointestinal cancers

    NASA Astrophysics Data System (ADS)

    Nadeau, Valerie; Padgett, Miles J.; Hewett, Jacqueline; Sibbett, Wilson; Hamdan, Khaled; Mohammed, Sami; Tait, Iain; Cushieri, Alfred

    2001-04-01

    We describe a compact endoscopic imaging system for the detection of gastro-intestinal cancers. This system is designed to image ALA-induced PpIX fluorescence and allows the clinician to perform fluorescence endoscopy and white light endoscopy simultaneously. The system comprises a filtered mercury arclamp for illumination and fluorescence excitation, a dual camera system coupled to an endoscope for detection and a desktop PC for processing and display of images. The result is a real-time colour image onto which fluorescence information is superimposed. Preliminary in vivo results indicate an increased fluorescence level within cancers in comparison with normal tissue. In addition, the system allows point spectroscopy to be carried out by the insertion of an optical fibre probe down the biopsy channel of the endoscope.

  19. ENDOSCOPIC SLEEVE GASTROPLASTY - MINIMALLY INVASIVE THERAPY FOR PRIMARY OBESITY TREATMENT

    PubMed Central

    GALVÃO-NETO, Manoel dos Passos; GRECCO, Eduardo; de SOUZA, Thiago Ferreira; de QUADROS, Luiz Gustavo; SILVA, Lyz Bezerra; CAMPOS, Josemberg Marins

    2016-01-01

    ABSTRACT Background: Less invasive and complex procedures have been developed to treat obesity. The successful use of Endoscopic Sleeve Gastroplasty using OverStitch(r) (Apollo Endosurgery, Austin, Texas, USA) has been reported in the literature. Aim: Present technical details of the procedure and its surgical/ endoscopic preliminary outcome. Method: The device was used to perform plications along the greater curvature of the stomach, creating a tubulization similar to a sleeve gastrectomy. Result: A male patient with a BMI of 35.17 kg/m2 underwent the procedure, with successful achievement of four plications, and preservation of gastric fundus. The procedure was successfully performed in 50 minutes, time without bleeding or other complications. The patient presented mild abdominal pain and good acceptance of liquid diet. Conclusions: The endoscopic gastroplasty procedure was safe, with acceptable technical viability, short in duration and without early complications. PMID:27683786

  20. Indigo Carmine for the Selective Endoscopic Intervertebral Nuclectomy

    PubMed Central

    Kim, Inn-Se; Shin, Sang-Wook; Kim, Tae-Kyun; Kim, Jeung-Il

    2005-01-01

    This study was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc. PMID:16100472