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Endoscopic Intervention (endoscopic + intervention)
Selected AbstractsSuccessful Endoscopic Band Ligation for Treatment of Postpolypectomy HemorrhageDIGESTIVE ENDOSCOPY, Issue 4 2000Yohei Mizuta We describe a case of large pedunculated tubulovillous adenoma of the stomach associated with postpolypectomy hemorrhage, which was successfully treated by endoscopic band ligation. The case study involved a 60-year-old Japanese woman with a pedunculated polyp with a slightly lobular surface, measuring 25 mm in diameter. It was detected on the posterior wall of the middle body of the gastric remnant. The lesion was diagnosed as a tubulovillous adenoma by a biopsy specimen and treated by endoscopic polypectomy using the detachable snare to prevent postpolypectomy hemorrhage. There was no episode of immediate postpolypectomy hemorrhage, but hematemesis occured 18 h after the excision. Endoscopic examination of the stomach showed the mark left by bleeding on the cutting surface and the absence of the detachable snare. Endoscopic intervention by rubber band ligation was performed to prevent the recurrent bleeding. Complete hemostasis was obtained and no serious complications occured. [source] Rate of bilirubin regression after stenting in malignant biliary obstruction for the initiation of chemotherapyCANCER, Issue 11 2008How soon should we repeat endoscopic retrograde cholangiopancreatography? Abstract BACKGROUND. This study was conducted to evaluate the rate of regression of bilirubin after stent placement for malignant biliary obstruction. METHODS. Records were reviewed from October 2002 to September 2005 for patients who underwent endoscopic retrograde cholangiopancreatography with stent placement. The time to achieve a bilirubin level ,2 mg/dL was the primary endpoint because this is the level required by most chemotherapy protocols. Patient variables included type of cancer, liver metastasis, recent chemotherapy, baseline creatinine, and international normalized ratio (INR). Stent variables included type, dimension, stricture location, and sphincterotomy. RESULTS. In total, 156 patients were included in the analysis: Ninety-three patients achieved a poststent bilirubin level ,2 mg/dL, 29 patients failed because of stent failure, and 34 patients failed because of inadequate follow-up. The time required for 80% of patients to achieve normalization was more than doubled in those who had prestent bilirubin levels ,10 mg/dL (6 weeks) compared with those who had prestent bilirubin levels <10 mg/dL (3 weeks). The following variables were identified as statistically significant: prestent bilirubin level, stricture location, liver metastasis, and INR. The cancer type, recent chemotherapy, stent type and diameter, and sphincterotomy were not statistically significant variables. CONCLUSIONS. The rate of bilirubin normalization after biliary stenting was highly dependent on the prestent bilirubin level. Endoscopic intervention should be considered in patients who fail to achieve adequate normalization of serum bilirubin in 6 weeks if prestent bilirubin level was ,10 mg/dL and in 3 weeks if their prestent bilirubin level was <10 mg/dL. Independent variables, such as diffuse liver metastases, stricture outside the common bile duct, and elevated INR had predictive value for bilirubin normalization. Cancer 2008. © 2008 American Cancer Society. [source] The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhageINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010R. Srirajaskanthan Summary Background:, Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. Methods:, A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re-bled, represented with further bleeding, or who died. Results:, A total of 174 patients were seen with UGI bleeding. Eight of them self-discharged and were excluded. Of the remaining 166, 94 had a ,low risk' bleed, and 72 ,high risk'. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver-operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95,1.00). When a cut-off value of , 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut-off value of , 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. Conclusions:, The GBS accurately identifies low risk patients who could be managed safely as outpatients. [source] Late surgical complications following liver transplantationLIVER TRANSPLANTATION, Issue S2 2009Paige M. Porrett Key Points 1. Biliary strictures and incisional hernias are the most common surgical complications encountered late after liver transplantation. 2. Anastomotic biliary strictures are amenable to endoscopic intervention and rarely need surgical intervention. 3. The presence of a biliary stricture mandates an evaluation of the patency of the hepatic artery. 4. Ischemic-type intrahepatic strictures are common indications for retransplantation. 5. Recipients of living related liver transplantation and donation after cardiac death allografts are at the highest risk for biliary and vascular complications late after transplantation. Liver Transpl 15:S12,S18, 2009. © 2009 AASLD. [source] Outcome of endoscopy surveillance for Barrett's oesophagusANZ JOURNAL OF SURGERY, Issue 11 2009Tim Bright Abstract Background:, Endoscopic surveillance of individuals with Barrett's oesophagus is undertaken to detect early stage oesophageal malignancy. The impact of a surveillance programme on endoscopy resources and disease detection is uncertain. Methods:, In 2004, we commenced a structured Barrett's oesophagus surveillance programme. The surveillance protocol specifies surveillance interval and number of oesophageal biopsies required according to previous endoscopy and biopsy findings. The first 3 years of surveillance were reviewed to assess programme adherence, impact on endoscopy resources and the incidence of high-grade dysplasia and adenocarcinoma in patients undergoing surveillance. Results:, Four hundred five patients were enrolled in the surveillance programme, and 776 patient years of endoscopy follow-up were analysed. Four-quadrant biopsies every 2 cm throughout the Barrett's oesophagus were performed in 89.8% of endoscopies. A total of 93.7% of patients had surveillance endoscopy performed at the appropriate time interval. Formalizing surveillance was followed by a decrease in the mean time interval for endoscopy surveillance from 16 months to 15 months, although the mode endoscopy surveillance interval lengthened from 1 year to 2 years. The mean number of biopsies per endoscopy increased from 5.9 to 7. In four patients, T1 stage oesophageal adenocarcinoma was identified, and in six patients, high-grade dysplasia was identified (combined incidence of adenocarcinoma/high-grade dysplasia 1 per 77.6 endoscopy years of follow-up). Conclusions:, Structured Barrett's surveillance detects malignant progression at an early stage, which provides opportunities for curative surgical or endoscopic intervention. Formalizing surveillance resulted in a high rate of adherence to agreed guidelines and rationalized the use of endoscopy resources without significantly increasing workload. [source] The Glasgow Blatchford scoring system enables accurate risk stratification of patients with upper gastrointestinal haemorrhageINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2010R. Srirajaskanthan Summary Background:, Upper gastrointestinal (UGI) haemorrhage is a frequent cause of hospital admission. Scoring systems have been devised to identify those at risk of adverse outcomes. We evaluated the Glasgow Blatchford score's (GBS) ability to identify the need for clinical and endoscopic intervention in patients with UGI haemorrhage. Methods:, A retrospective observational study was performed in all patients who attended the A&E department with UGI haemorrhage during a 12-month period. Patients were separated into low and high risk categories. High risk encompassed patients who required blood transfusions, operative or endoscopic interventions, management on high dependency or intensive care units, and those who re-bled, represented with further bleeding, or who died. Results:, A total of 174 patients were seen with UGI bleeding. Eight of them self-discharged and were excluded. Of the remaining 166, 94 had a ,low risk' bleed, and 72 ,high risk'. The GBS was significantly higher in the high risk (median = 10) than in the low risk group (median 1, p < 0.001). To assess the validity of the GBS at separating low and high risk groups, receiver-operator characteristic (ROC) curves were plotted. The GBS had an area under ROC curve of 0.96 (95% CI 0.95,1.00). When a cut-off value of , 3 was used, sensitivity and specificity of GBS for identifying high risk bleeds was 100% and 68%. Thus at a cut-off value of , 2 the GBS is useful for distinguishing those patients with a low risk UGI bleed. Conclusions:, The GBS accurately identifies low risk patients who could be managed safely as outpatients. [source] BT03 SILASTIC RING MINI GASTRIC BYPASS FOR MORBID OBESITY: THE NEW ZEALAND EXPERIENCEANZ JOURNAL OF SURGERY, Issue 2009K. C. Wong Purpose: , The laparoscopic mini gastric bypass (LMGB) is purportedly a technically simpler, yet equally effective operation to the laparoscopic Roux-en-Y gastric bypass as treatment for morbid obesity. This study reports the early results of LMGB in a major New Zealand bariatric centre. Methodology: , Clinical data was prospectively collected on all patients undergoing LMGB over a two year period. Results: , 142 patients were studied. 77% were females. Mean age was 43.8. Pre-operative mean body weight and body mass index (BMI) were 121.3 kg and 45.4 kg/m2 respectively. Mean BMI at one and two years follow up had decreased to 27.35 and 25.72 kg/m2 respectively. 83% of patients reported obesity associated co-morbidities pre-operatively. Post-operatively, 78% of patients reported a reduction in medication requirement. All surgery was performed laparoscopically. There were no anastomotic leaks and zero mortality. 8% of patients required further operations for complications or revision to a Roux-en-Y gastric bypass. 20% of patients required subsequent endoscopic interventions, the majority for investigation of vomiting and/or pain. 22% of patients required re-admission. 14% of patients reported new onset reflux or worsening of pre-existing reflux after LMGB. 82% of patients reported increased exercise capability post LMGB. 54% of patients required vitamin supplementation. Conclusion: , LMGB achieves significant weight loss and resolution of obesity related co-morbidities with a low short term complication rate. LMGB should be considered as a safe and simple surgical option for morbid obesity. [source] | ||||||||||