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Stone Clearance (stone + clearance)
Selected AbstractsRISK FACTORS FOR RECURRENT BILE DUCT STONES AFTER ENDOSCOPIC PAPILLARY BALLOON DILATION: LONG-TERM FOLLOW-UP STUDYDIGESTIVE ENDOSCOPY, Issue 2 2009Akira Ohashi Background:, Little is known about the long-term results of endoscopic papillary balloon dilation (EPBD) for bile duct stones. Methods:, Between 1995 and 2000, 204 patients with bile duct stones successfully underwent EPBD and stone removal. Complete stone clearance was confirmed using balloon cholangiography and intraductal ultrasonography (IDUS). Long-term outcomes of EPBD were investigated retrospectively in the year 2007, and risk factors for stone recurrence were multivariately analyzed. Results:, Long-term information was available in 182 cases (89.2%), with a mean overall follow-up duration of 9.3 years. Late biliary complications occurred in 22 patients (12.1%), stone recurrence in 13 (7.1%), cholangitis in 10 (5.5%), cholecystitis in four, and gallstone pancreatitis in one. In 11 of 13 patients (84.6%), stone recurrence developed within 3 years after EPBD. All recurrent stones were bilirubinate. Multivariate analysis identified three risk factors for stone recurrence: dilated bile duct (>15 mm), previous cholecystectomy, and no confirmation of clean duct using IDUS. Conclusion:, Approximately 7% of patients develop stone recurrence after EPBD; however, retreatment with endoscopic retrograde cholangiopancreatography is effective. Careful follow up is necessary in patients with dilated bile duct or previous cholecystectomy. IDUS is useful for reducing stone recurrence after EPBD. [source] Impact of anatomical pielocaliceal topography in the treatment of renal lower calyces stones with extracorporeal shock wave lithotripsyINTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2005LORENZO RUGGERA Abstract Aim:, There is wide consensus that the lowest success rate of extracorporeal shock wave lithotripsy (ESWL) is in the complete clearance of renal stones located in the lower calyces. We assess the effectiveness of extracorporeal shock wave lithotripsy monotherapy for lower pole renal calculi to determine the relationship between the spatial anatomy of lower pole and the outcome of ESWL. Methods:, We evaluated 107 patients who were treated for solitary lower pole renal stones less than 20 mm in diameter with ESWL. The spatial anatomy of the lower pole, as defined by the lower infundibulopelvic angle, infundibular length and infundibular width, was measured by preoperative intravenous pyelography, while the stone location and size were determined by using abdominal plain X-ray. All patients were followed up at 1 and 3 months with abdominal plain X-ray and ultrasonography. Results:, Only 62 patients (58%) became stone free, while 45 (42%) retained residual fragments. A small lower infundibulopelvic angle, a long infundibular length and a tight infundibular width are unfavorable for stone clearance after ESWL. Conclusions:, ESWL is the treatment of choice for most renal and ureteral stones. However, stone clearance from the lower pole following ESWL is poor and significantly affected by the inferior pole collecting system anatomy. Therefore, we believe it is important to evaluate these anatomical factors when deciding on the best treatment for lower pole renal calculi. [source] Lower pole ratio: A new and accurate predictor of lower pole stone clearance after shockwave lithotripsy?INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2004YAN KIT FONG Abstract Background: Lower pole spatial anatomy is an important determinant of success after extracorporeal shockwave lithotripsy. In the present study, we determine whether there is a significant relationship between lower pole ratio (infundibular length : infundibular width) on preoperative intravenous urograms and stone fragment clearances after shockwave lithotripsy. Methods: A total of 42 patients with isolated lower pole stones were retrospectively reviewed. Anatomical factors, such as infundibular length, width and infundibulopelvic angle were measured and the lower pole ratio was calculated on pretreatment intravenous urogram. Stone fragment clearance was assessed at three months with a plain abdominal X-ray. Results: The overall three-month stone-free rate was 62%. Mean stone size ± SD was 10 ± 4.8 mm, mean infundibular length was 21.7 ± 6.9 mm, mean infundibular width was 6.1 ± 2.3 mm, mean infundibulopelvic angle was 62.1 ± 30.1 degrees and mean lower pole ratio was 4.3 ± 2.8. Stone-free status after shockwave lithotripsy was significantly related to infundibular length and width as well as to lower pole ratio, but not to infundibulo-pelvic angle. Infundibular length less than 30 mm, width greater than 5 mm and lower pole ratio less than 3.5 were noted to have an improved three-month stone-free rate (P = 0.049, 0.01 and <0.01, respectively). Conclusion: Caliceal anatomy is an important consideration for lower pole stone clearance after shockwave lithotripsy. The present study suggests that a lower pole ratio of less than 3.5, which considers both infundibular length and width, is a promising predictor for stone-free status. [source] MINOR PAPILLA SPHINCTEROTOMY FOR PANCREATITIS DUE TO PANCREAS DIVISUMANZ JOURNAL OF SURGERY, Issue 4 2008Vu Kwan Background: Pancreas divisum (PD) is the commonest congenital pancreatic abnormality and is implicated as a cause of acute recurrent pancreatitis (ARP). We report our experience in minor papilla sphincterotomy (MPS) for this condition. Studies published at present have not examined MPS as the primary treatment method in a homogenous (i.e. only those with ARP) patient group. Methods: Patients with PD and ARP were identified from an endoscopic database. Treatment protocol consisted of minor papilla guidewire cannulation and sphincterotomy with either sphincterotome over the wire or needle knife over pancreatic stent. A 5-Fr stent was placed for 1 week. Adjunctive therapy was carried out as required. Follow-up data was collected by interview with the patient and referring doctors and review of the medical record. Results: Twenty-one patients underwent MPS for PD and ARP (median age = 33 years, range 9,77 years, men = 14). Median number of procedures to achieve cannulation and MPS was 1 (range 1,3). Complications encountered were pancreatitis (n = 2) and pain (n = 3). MPS restenosis occurred in 2. Adjuvant therapy was required in 14: stricture dilatation (n = 9), stone extraction (n = 7) and extracorporeal shock-wave lithotripsy (n = 6). Complete stone clearance was achieved in 7/7. Median follow up was 38 months (range 4,67 months). Median total number of pancreatitis episodes and hospitalizations pre-MPS were 4 and 2, respectively (range 1,20 and 0,5, respectively). Post-MPS these were reduced to 0 and 0, respectively (range 0,8 and 0,4; P = 0.0007 and P = 0.0003), with complete abolition of episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with ARP and PD. Complete clinical resolution occurs in the majority. Treatment is safe, and the response is durable. [source] Biliary access loops for intrahepatic stones: results of jejunoduodenal anastomosisANZ JOURNAL OF SURGERY, Issue 5 2003Hariharan Ramesh Background: Patients with intrahepatic calculi require multiple interventions following successful surgical stone clearance for recurrent stones and cholangitis. The present paper describes the results of a technique of in-continuity side-to-side jejunoduodenal anastomosis (JDA) that provides endoscopic access to the hepaticojejunostomy and intrahepatic ducts. This operation is compared to other techniques in a critical appraisal of various biliary access procedures described for long-term management of intrahepatic calculi. Methods: A retrospective analysis of clinical data of 13 patients who underwent biliary drainage procedures with access loops for intrahepatic calculi during the period March 1990 to December 2000 was performed. The postoperative course of patients and the feasibility of postoperative endoscopic access to the hepaticojejunostomy and intrahepatic ductal system in treatment of recurrent cholangitis were assessed. Nine patients underwent JDA, two underwent permanent-access hepaticojejunostomy (PAH) and two others underwent an interposition hepaticojejunoduodenostomy (IHJ). Results: The analysis revealed no major procedure-related complications or mortality. Endoscopic access (using forward-viewing gastroscope) was possible in 100% of cases following JDA, and with difficulty in both cases after PAH. Endoscopic access in the two patients with IHJ failed because of technical reasons. Recurrent cholangitis was seen in seven patients (54%) , two out of two patients in the PAH group, one out of two in the IHJ group and four out of nine in the JDA group. This required 12 endotherapy sessions (mean: 1.5 procedures per patient). Conclusion: In-continuity side-to-side JDA allows easy access of conventional gastroduodenoscopes to the biliary tree for removal of recurrent/residual intrahepatic stones. The technique has advantages over other access loop procedures in the long term management of recurrent intrahepatic stones. [source] Ureteric stents compromise stone clearance after shockwave lithotripsy for ureteric stones: results of a matched-pair analysisBJU INTERNATIONAL, Issue 1 2009Athanasios N. Argyropoulos OBJECTIVE To identify the effect of the presence of a ureteric stent on the outcome of extracorporeal shockwave lithotripsy (ESWL), by comparing patients with ureteric stones with matched-pair analysis. PATIENTS AND METHODS Patients undergoing ESWL with the Sonolith Vision lithotripter (Technomed Medical Systems, Vaulx-en-Velin, France) were identified from our prospectively maintained database. Only adult patients with a solitary, radio-opaque, previously untreated ureteric stone were considered for further analysis. A follow-up of ,3 months with a plain abdominal film was used to identify residual fragments. Patients were exactly matched for gender, side, location in the ureter and size (in two dimensions, within ±2 mm). If both diameters could not be matched exactly, the size was extended to ±1 mm and then to ±2 mm of both diameters. An effort was finally made to match patients by age. The treatment outcome in terms of stone-free rates was assessed and compared using McNemar's test. RESULTS In all, 45 patients with a ureteric stent in place during ESWL were identified. The only patient who could not be adequately matched was a 40-year-old man with an 8 × 3 mm stone in the upper ureter. The best/closest match for age was selected. Most stones were in the upper ureter (77%); the mean stone size was 8.5 and 8.6 mm, respectively, with no statistical differences between the groups for age and size of stones (P = 0.41 and 0.86, Student's t -test). In 12 pairs, only patients with no stent were stone-free, compared to two pairs where the patient with a stent was stone-free. Using McNemar's test, the odds ratio was 6.0 (95% confidence interval 1.3,55.2) and the difference between the groups was statistically significant (P = 0.016). CONCLUSION These results show that the presence of a stent is associated with a worse outcome after ESWL for ureteric stones. Ureteric stents should still be used in cases of obstruction, when there is a risk of sepsis, and in patients with intolerable pain or deteriorating renal function. However, their use in patients offered ESWL for ureteric stones should be considered with caution. [source] | ||||||||||