1,721,095 research outputs found
Removal of a large rectal polyp with endoscopic submucosal dissection-trans-anal rectoscopic assisted minimally invasive surgery hybrid technique: A case report
Full text linkBackground: Endoscopic submucosal dissection (ESD) can be used for the en-bloc removal of superficial rectal lesions; however, the lack of a traction system makes the procedure long and difficult in the presence of extensive lesions. Case summary: A large polyp occupying 2/3 of the rectal circumference and extending 5 cm in length was removed by ESD with the help of laparoscopic forceps introduced via trans-anal rectoscopic assisted minimally invasive surgery, a disposable platform designed to aid in transanal minimally invasive surgery. Traction of the polyp by forceps during the operation was dynamic, and applied at various points and in various directions. The polyp was removed en-bloc without complications in 1 h and 55 min. A sigmoidoscopy performed 50 d later showed normal healing without polyp recurrence. Conclusion: The technique presented here could overcome the issues caused by lack of traction during ESD for rectal lesions
Operative endoscopy for benign gastro-intestinal lesions
Full text linkOperative endoscopy has proven to be a discipline that continually renews itself. Referrals for treatment using flexible endoscopes in the gastroenteric tract are in fact on the rise. Diagnoses made at earlier phases of the disease uncover pre cancerous lesions that can be treated locally. The technological development of endoscopic instruments, on the other, make it possible to enter into the abdominal cavity and to go beyond the intestinal lumen and to carry out mini-invasive surgical procedures.
Operative endoscopy must, of course, confront and collaborate with other traditional disciplines such as pharmacological therapy, interventistic radiology, and, above all, traditional surgery. It must, in particular, join hands with the latter placing itself at its service in the treatment of anastomic complications and imitating it in the development of miniinvasive endoluminal surgery. Some fields of application of operative endoscopy used in the treatment of benign lesions of the gastroenteric tract have been considered here. These include: endoscopic therapy of telangiectasia which represents its principal therapy once the disease has been staged and controlled; prophylactic ligation of esophageal varices in trasplant candidates who, due to their limited follow up, present more disadvantages than advantages with regards to propranolol therapy, laser therapy of Barrett's esophagus which aims to reduce the risk of adenomacarcinoma of the esophagus by ablating metaplasic tissue - further studies are warranted here to quantify its effect; laser therapy of large colorectal adenomas found to be an efficacious alternative to surgery in inoperable patients or those who reject surgery, avoiding the risk of degeneration; treatment of anastomic complications in esophageal surgery and in liver transplant patients in whom endoscopic therapy is the first choice therapy, and finally drainage of abdominal abscesses and necrosectomy carried out endoscopically with the aid of ecoendoscopy, which has taken operative endoscopy beyond the intestinal lumen.
The latter field of application is a first step, already in fact utilized in clinical practice, towards the development of NOTES, the new miniinvasvie surgical discipline, still in an experimental stage but already being watched with great interest by the endoscopic and surgical worlds
Endoscopic ultrasound guided drainage of a pancreatic pseudocyst: a case report of a fistula to the common bile duct
Full text linkReply: Prophylactic Variceal Ligation Is Not Recommended for Patients Awaiting Live Donor Liver Transplant.
No full textWe thank Wai and colleagues1 for their comment on our article.2 Their experience is consistent with ours and different from that reported by Jutabha et al.3 In all 3 studies, the patients were liver transplant candidates and thus constituted a particular subgroup of patients with cirrhosis, as underlined also by Boyer.4 In our opinion, this favors the use of beta-blockers instead of banding for primary prophylaxis for at least 2 reasons. The first, as underlined by Wai et al., is the short follow-up before liver transplantation. In fact, as shown in Fig. 2 of our study, patients treated by ligation can bleed during treatment but not after variceal eradication unless varices recur. In contrast, patients taking beta-blockers present the same risk of bleeding over the same time period. As a result, a possible advantage of banding can be seen only after a long follow-up, which is unlikely in patients awaiting liver transplant as usually this occurs within 1 year. The other reason is that this group of patients is followed up intensively, and this may increase compliance to therapy. The use of beta-blockers does require dose adjustment and trying to maximize the dose tolerated by the patient.
The 2 bleeding episodes from postbanding ulcers reported by Wai et al.1 are added to several others that have taken place during prophylactic treatment, including 2 events described in our study. Globally, the reported cases number at least 15, some of which have been fatal. In contrast, beta-blockers for primary prophylaxis of variceal bleeding have not caused fatalities thus far.5
It is difficult to predict which patients are at risk for postbanding ulcer bleeding. Our patients bled 9 and 11 days after the first banding session, respectively. One was Child B7, and the other was Child C14. The patients treated by Wai et al.1 bled 8 and 9 days after the second prophylactic ligation. Shepke et al.6 reported 5 (7%) bleeding episodes from postbanding ulcers, 2 of them fatal. The latter happened 3 and 12 days after the first banding session, respectively. Triantos et al.,7 treating patients unable to take beta-blockers, reported 3 cases of variceal bleeding, all between the first and second prophylactic banding sessions. As most bleeding occurs after the first banding session, we think that longer intervals between sessions, advocated by some authors to overcome this problem,5 would not reduce this risk. In addition and not to be discounted, we found that the costs are reduced to a third when beta-blockers are used with respect to banding for primary prophylaxis in these patients. Thus, nonselective beta-blockers remain the therapy of first choice for primary prophylaxis in liver transplant candidates
Adenomas at resection margins do not influence the long-term development of pouch polyps after restorative proctocolectomy for familial adenomatous polyposis
No full textBackground: The aim of this study was to consider whether adenomas in the resection margins could represent a risk factor for pouch
polyps in familial adenomatous polyposis (FAP) patients.
Methods: We reviewed 46 patients treated by restorative proctocolectomy (RPC) for FAP: 9 hand-sewn and 37 stapled ileal pouch–anal
anastomosis (IPAA). We analyzed the presence of polyps in the doughnuts from stapled anastomosis and in the resection margins from
hand-sewn anastomosis. The presence of polyps in the IPAA was then assessed in 30 patients (6 hand-sewn and 24 stapled IPAA): 4 from
the histology of the excised pouch and 26 by endoscopy (range 4 months to 12 years after operation, mean 6 years).
Results: Surprisingly, pouch adenomas were found in only 2 of 30 (7%) of patients, 1 of 6 hand-sewn and 1 of 24 stapled anastomosis (P
0.1), 9 and 11 years, respectively, after operation. However, there were 6 patients with inflammatory (3), fibroepithelial (2), or lymphoid
(1) polyps. The risk of pouch adenomas after 8 years was 20% (P 0.05). Pouch adenomas were found in 1 of 11 patients having adenomas
in the margins or in the doughnuts (9%) and in 1 of 19 with no adenomas at the margins (5%; P 0.1).
Conclusions: Incidence of pouch adenomas was low. There was no correlation between adenomas in the resection margins and the development of pouch adenomas. © 2003 Excerpta Medica, Inc. All rights reserved
Evidence that Enterobius vermicularis plays a causative role for PFAPAand recurrent aphthous stomatitis
No full text
Diagnostic flexible laparoscopy: a single incision procedure.
No full textA novel, minimally invasive diagnostic laparoscopy procedure is described in this report. After positioning a percutaneous trocar and inducing CO2 pneumoperitoneum, a flexible endoscope is introduced through the trocar to inspect intra-abdominal organs, including the surface of the liver, the gallbladder, the stomach, the intestine, the pelvic organs, and free intraperitoneal fluid. Simple procedures such as gathering histological or cytological samples, intraperitoneal lavage, collecting peritoneal fluid for culture, removing adhesions and cyst puncturing are carried out at the endoscopic surgeon's discretion through 1 or 2 working channels. Only a single incision is necessary and, unlike Natural Orifice Translumenal Endoscopic Surgery, visceral iatrogenic perforations are unnecessar
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