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Endoscopic Applications (endoscopic + application)

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Medical Sciences	100%

Selected Abstracts

Endoscopic fibrin sealing of gastrocutaneous fistulas after sleeve gastrectomy and biliopancreatic diversion with duodenal switch

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 12 2008
Theodossis S Papavramidis
Abstract Background and Aim:, Gastrocutaneous fistulas (GCF) are uncommon complications accounting for 0.5,3.9% of gastric operations. When their management is not effective, the mortality rate is high. This study reports the conservative treatment of GCF in morbidly obese patients who underwent biliopancreatic diversion with duodenal switch. Methods:, Ninety-six morbidly obese patients were treated in our department with biliopancreatic diversion with duodenal switch (Marceau technique) and, in six of them, a high-output GCF developed. A general protocol was applied to all patients presenting a GCF. Everyone was treated by total parenteral nutrition (TPN) and somatostatin for at least 7 days after the appearance of the leak. If the leak continued, then fibrin glue was used as a tissue adhesive. Endoscopic application of the sealant was accomplished under direct vision via a double-lumen catheter passed through a forward-viewing gastroscope. Results:, All patients were treated successfully with conservative treatment (either solely with TPN and somatostatin, or with endoscopic fibrin sealing sessions). No evidence of fistula was observed at gastroscopy 3 and 24 months after therapy. Conclusion:, The conservative treatment of GCF following biliopancreatic diversion with duodenal switch is highly effective. All patients should enter a protocol that includes TPN and somatostatin. When the GCF persist, endoscopic sealing glue should be considered before operation because it is simple, safe, effective and, in some cases, life-saving. Therefore, conservative treatment should be employed as a therapeutic option in GCF developing after bariatric surgery. [source]

Comparison of germanium oxide fibers with silica and sapphire fiber tips for transmission of erbium: YAG laser radiation

LASERS IN SURGERY AND MEDICINE, Issue 8 2006
Travis J. Polletto BS
Abstract Background and Objectives Endoscopic applications of the Erbium:YAG laser have been limited due to the lack of a suitable optical fiber delivery system. The purpose of this study was to compare the transmission of Er:YAG laser radiation through germanium oxide trunk fibers with silica and sapphire fiber tips for potential use in contact tissue ablation during endoscopy. Study Design/Materials and Methods Er:YAG laser radiation with a wavelength of 2.94 µm, pulse length of 300 microseconds, pulse energies from 5 to 1,360 mJ, coupled into pulse repetition rates of 3,10 Hz, was through 1-m-long germanium oxide fibers with either 1-cm-long, 550-µm-diameter silica or sapphire tips. Results Transmission through the germanium oxide/sapphire fibers measured 65±5% compared with 55±4% for the germanium oxide/silica fibers (P<0.05). The damage threshold for the hybrid fibers averaged 309± 44 mJ and 126±43 mJ, respectively (n,=,7 fibers each) (P<0.05). The highest pulse energies transmitted through the fibers were 700 mJ and 220 mJ, respectively. Conclusions Improved index-matching of the trunk fiber and fiber tip at 2.94 µm resulted in higher transmission and damage thresholds for the germanium oxide/sapphire fibers. The germanium oxide/sapphire fiber may represent a promising mid-infrared optical fiber delivery system for use in endoscopic applications of the Er:YAG laser requiring a flexible, biocompatible, and robust fiber delivery system for contact tissue ablation. Lasers Surg. Med. 38:787,791, 2006. © 2006 Wiley-Liss, Inc. [source]

Hybrid germanium/silica optical fibers for endoscopic delivery of erbium:YAG laser radiation

LASERS IN SURGERY AND MEDICINE, Issue 1 2004
Charles A. Chaney MS
Abstract Background and Objectives Endoscopic applications of the erbium (Er):YAG laser have been limited due to the lack of an optical fiber delivery system that is robust, flexible, and biocompatible. This study reports the testing of a hybrid germanium/silica fiber capable of delivering Er:YAG laser radiation through a flexible endoscope. Study Design/Materials and Methods Hybrid optical fibers were assembled from 1-cm length, 550-,m core, silica fiber tips attached to either 350- or 425-,m germanium oxide "trunk" fibers. Er:YAG laser radiation (,,=,2.94 ,m) with laser pulse lengths of 70 and 220 microseconds, pulse repetition rates of 3,10 Hz, and laser output energies of up to 300 mJ was delivered through the fibers for testing. Results Maximum fiber output energies measured 180±30 and 82±20 mJ (n,=,10) under straight and tight bending configurations, respectively, before fiber interface damage occurred. By comparison, the damage threshold for the germanium fibers without silica tips during contact soft tissue ablation was only 9 mJ (n,=,3). Studies using the hybrid fibers for lithotripsy also resulted in fiber damage thresholds (55,114 mJ) above the stone ablation threshold (15,23 mJ). Conclusions Hybrid germanium/silica fibers represent a robust, flexible, and biocompatible method of delivering Er:YAG laser radiation during contact soft tissue ablation. However, significant improvement in the hybrid fibers will be necessary before they can be used for efficient Er:YAG laser lithotripsy. Lasers Surg. Med. 34:5,11, 2004. © 2004 Wiley-Liss, Inc. [source]

Comparison of germanium oxide fibers with silica and sapphire fiber tips for transmission of erbium: YAG laser radiation

Side-firing sealing caps for hollow optical fibers

LASERS IN SURGERY AND MEDICINE, Issue 8 2006
Tomonori Watanabe BS
Abstract Background and Objectives Hollow optical fibers are useful for delivery of high-energy infrared laser beam such as Er:YAG lasers. We propose side-firing optics for hollow optical fibers for laser endoscopic applications mainly in oto-rhino-laryngology and urology. Study Design/Materials and Methods To produce a circular beam, cone-shaped caps are designed and caps with slanted end are proposed for producing a spot beam in side direction. Both types of caps are fabricated by fusing and polished Pyrex and silica glass tubes. Results For the both of the cone-shaped and slanted-end caps effectively deflect laser beam as designed and these caps show high durability for Er:YAG laser light with pulse energy higher than 100 mJ. Conclusions By choosing the proper shape of the cap ends, these caps deflect an input laser beam to a preferred direction at low insertion losses. By using these side-firing optics, one can easily irradiate the inside of tubular organs. Lasers Surg. Med. 38:792,797, 2006. © 2006 Wiley-Liss, Inc. [source]