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Benign Strictures (benign + stricture)
Selected AbstractsPERORAL PANCREATOSCOPY: CURRENT STATUS AND FUTURE EXPECTATIONS USING NARROW BAND IMAGINGDIGESTIVE ENDOSCOPY, Issue 2007Yoshifumi Arisaka Peroral pancreatoscopy (POPS) under duodenoscopic assistance provide direct visual assessment of the pancreatic duct, tissue sampling, and therapeutic interventions. Sometimes, pancreatoscopy can confirm accurate diagnosis, such as differential diagnosis of filling defects between intraductal tumors and stones. However, it is often difficult to differentiate malignant from benign strictures solely on pancreatoscopy. It is currently considered that intraductal papillary mucinous neoplasm (IPMN) is the most suitable indication of POPS. POPS has several problems: image resolution, fragility and maneuverability. Concerning image resolution, the quality has been improved with the development of a video pancreatoscope. Moreover, the recently developed endoscopic optical technology of narrow band imaging (NBI) is now available to video pancreatoscopy. This will allow direct visual assessment. Although currently POPS has several problems, further improvement will assist POPS to become a useful modality in combination with NBI. [source] ENDOSCOPIC MANAGEMENT OF BILIARY and PANCREATIC DUCTS STRICTURESDIGESTIVE ENDOSCOPY, Issue 2004Hiroyuki Maguchi ABSTRACT Endoscopic treatment is applied to a relatively large number of biliary and pancreatic duct strictures, and is a practical matter. It is essential to select the most appropriate treatment for each lesion. For instance, when treating malignant biliary stricture, accurate diagnosis of whether surgical treatment is required or not is vital; and in choosing a stent for an inoperable case, location of the stricture, with or without anticancer treatment, prognosis, and management of possible post-stenting re-stricture must be taken into consideration. For benign strictures, not only short-term results in mobility and motality, but also decades of long-term results must be cautiously questioned. Bearing these in mind, we need to accumulate the worldwide data of the treatments and establish a proper treatment guideline. [source] EXPERIENCES OF SELF-EXPANDABLE METALLIC STENT FOR COLORECTAL OBSTRUCTIONS: 70 CASESDIGESTIVE ENDOSCOPY, Issue 2004Yoshihisa Saida ABSTRACT Clinical utilization of self-expandable metallic stent (EMS) endoprosthesis has come later for colorectal diseases than for other lesions. Recently, EMS has been used for palliative insertions for strictures caused by malignant diseases or as a ,bridge to surgery' for obstructive colorectal cancers, with good clinical results increasingly reported in many western countries. Its application for benign strictures has been reported, but we believe that the surgical indications require more careful analysis because of the absence of data concerning long-term prognosis. The advantage of this technique in the treatment of colorectal strictures is that it limits invasiveness, such as in palliative or temporary stoma creation, thereby improving patient quality-of-life. Therefore, we believe that EMS endoprosthesis will play a key role in this field. We are awaiting the introduction of the metallic stent for the colon and the associated kit, as well as the Japanese government's approval for reimbursement for this procedure. [source] Gastrointestinal and biliary stentsJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2010Hoon Jai Chun Abstract Advances in stent design have led to a substantial increase in the use of stents for a variety of malignant and benign strictures in the gastrointestinal tract and biliary system. Whereas early stents were mostly composed of plastic, the majority of contemporary stents are self-expanding metal stents that are composed of either nitinol or stainless steel. These stents are able to exert an adequate expansile force and, at the same time, are highly flexible and biocompatible. Covered stents have been introduced to minimize tumor ingrowth through the metal mesh but are associated with higher rates for spontaneous migration. This has led to the development of covered stents with uncovered ends and stents with both covered and uncovered layers. Drug-eluting and biodegradable stents are also likely to become available in the near future. Although stents appear to be the preferred form of palliation for some patients with advanced cancer, many patients will benefit from a multidisciplinary approach that usually includes surgeons and oncologists. [source] Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2008Lakshmana Ayaru Abstract Background:, Self-expanding metal bile duct stents provide good palliation for inoperable malignant disease. However, problems may arise if metal stents are inserted before definitive histological diagnosis. The aim of this study was to evaluate the outcome of such patients. Methods:, A retrospective case note review was conducted of patients referred to a tertiary pancreaticobiliary center between 1992 and 2004 in whom a metal bile duct stent was inserted for presumed unresectable malignant disease before definitive histological diagnosis. Results:, There were 21 patients identified. Final diagnoses were: group 1, benign disease (n = 3); group 2, resectable malignancy (n = 2); group 3, unresectable malignancy (n = 12); and group 4, diagnosis remains uncertain (n = 4). During a follow-up of 22, 38 and 111 months, the patients in group 1 had one, eight and five episodes of stent occlusion. In group 2, both patients underwent pancreaticoduodenectomy for ampullary carcinoma, 2 and 6 months after presentation. In group 3, the median time to a confirmed malignant diagnosis was 2 months (range 1,27 months). In group 4, a median of two biopsies (range 1,4) were negative for malignancy, during a median follow up of 13 months (range 3,46). Overall in eight patients, the metal stents caused artifacts on computed tomography and/or were associated with tissue in-growth making the differentiation between benign and malignant disease difficult. Conclusion:, These cases indicate that metal bile duct stent insertion before definitive histological diagnosis can be problematic. A proportion of cases will have benign strictures and in others the confirmation of malignancy may be made more difficult. [source] | ||||||||||