ABSTRACT
AIM: To present a case series of MRCP-guided endoscopic biliary stent placement, performed entirely without contrast injection. METHODS: Contrast-free endoscopic biliary drainage was attempted in 20 patients with malignant obstruction, unsuitable for resection on the basis of tumor extent or medical illness. MRCP images were used to confirm the diagnosis of tumor, to exclude other biliary diseases and to demonstrate the stenoses as well as dilation of proximal liver segments. The procedure was carried out under conscious sedation. Patients were placed in the left lateral decubitus position. The endoscope was inserted, the papilla identified and cannulated by a papillotome. A guide wire was inserted and guided deeply into the biliary tree, above the stenosis, by fluoroscopy. A papillotomy approximately 1 cm. long was performed and the papillotome was exchanged with a guiding-catheter. A 10 Fr, Amsterdam-type plastic stent, 7 to 15 cm long, was finally inserted over the guide wire/guiding catheter by a pusher tube system. RESULTS: Successful stent insertion was achieved in all patients. There were no major complications. Successful drainage, with substantial reduction in bilirubin levels, was achieved in all patients. CONCLUSION: This new method of contrast-free endoscopic stenting in malignant biliary obstruction is a safe and effective method of palliation. However, a larger, randomized study comparing this new approach with the standard procedure is needed to confirm the findings of the present study.
Subject(s)
Cholestasis/diagnosis , Cholestasis/therapy , Endoscopy/methods , Stents , Aged , Contrast Media/pharmacology , Drainage , Female , Fluoroscopy/methods , Humans , Male , Middle Aged , Pancreatic Neoplasms/surgery , Plastics , Treatment Outcome , Video RecordingABSTRACT
Hilar tumors have proven to be a challenge to treat and manage because of their poor sensitivity to conventional therapies and our inability to prevent or to detect early tumor formation. Endoscopic stent drainage has been proposed as an alternative to biliary-enteric bypass surgery and percutaneous drainage to palliate malignant biliary obstruction. Prosthetic palliation of patients with malignant hilar stenoses poses particular difficulties, especially in advanced lesions (type II lesions or higher). The risk of cholangitis after contrast injection into the biliary tree in cases where incomplete drainage is achieved is well known. The success rate of plastic stent insertion is around 80% in patients with proximal tumors. Relief of symptoms can be achieved in nearly all patients successfully stented.
Subject(s)
Bile Duct Neoplasms/surgery , Endoscopy/methods , Hepatic Duct, Common/surgery , Bile Duct Neoplasms/pathology , Cholangitis/etiology , Drainage/adverse effects , Hepatic Duct, Common/pathology , Humans , Risk Factors , StentsSubject(s)
Angiodysplasia/diagnosis , Capsule Endoscopy , Ileal Diseases/diagnosis , Angiodysplasia/complications , Angiodysplasia/pathology , Angiodysplasia/surgery , Gastrointestinal Hemorrhage/etiology , Humans , Ileal Diseases/complications , Ileal Diseases/pathology , Ileal Diseases/surgery , Male , Middle AgedABSTRACT
AIM: To evaluate the clinical and endoscopic patterns in a large series of patients with metastatic tumors in the stomach. METHODS: A total of 64 patients with gastric metastases from solid malignant tumors were retrospectively examined between 1990 and 2005. The clinicopathological findings were reviewed along with tumor characteristics such as endoscopic pattern, location, size and origin of the primary sites. RESULTS: Common indications for endoscopy were anemia, bleeding and epigastric pain. Metastases presented as solitary (62.5%) or multiple (37.5%) tumors were mainly located in the middle or upper third of stomach. The main primary metastatic tumors were from breast and lung cancer and malignant melanoma. CONCLUSION: As the prognosis of cancer patients has been improving gradually, gastrointestinal (GI) metastases will be encountered more often. Endoscopic examinations should be conducted carefully in patients with malignancies, and endoscopic biopsies and information on the patient's clinical history are useful for correct diagnosis of gastric metastases.
Subject(s)
Endoscopy, Digestive System/methods , Neoplasms/pathology , Stomach Neoplasms/secondary , Adult , Aged , Aged, 80 and over , Anemia/etiology , Biopsy , Female , Hemorrhage/etiology , Humans , Male , Middle Aged , Neoplasm Metastasis/pathology , Pain/etiology , Retrospective Studies , Stomach Neoplasms/pathology , Time FactorsABSTRACT
This report describes a case of successful endoscopic management of intragastric penetrated adjustable gastric band in a patient with morbid obesity. The favorable course of the case described here demonstrates that adjustable gastric bands in the process of migration need not be removed surgically in patients who are asymptomatic.
Subject(s)
Foreign-Body Migration/surgery , Gastroplasty/adverse effects , Gastroscopy/methods , Obesity, Morbid/surgery , Humans , Male , Middle AgedABSTRACT
Dieulafoy's lesion is an unusual cause of recurrent GI bleeding. This report describes a case of actively bleeding Dieulafoy's lesion of the small bowel in which the diagnosis was made by capsule endoscopy, followed by treatment with the use of push enteroscopy. The case illustrates that capsule endoscopy and enteroscopy are highly complementary in patients with small bowel diseases.