RESUMO
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the surgical treatment of choice for morbid obesity. Several therapeutic options to remove common bile duct (CBD) stones have been proposed in these patients. Laparoscopy-assisted transgastric ERCP (LATERCP) has a high success rate. However, the procedure is not fully standardized and some technical variations have been proposed. We introduce two cases in which laparoscopic transgastric ERCP has been used to treat choledocholithiasis after LRYGB (AU)
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Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica , Laparoscopia , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Derivação Gástrica/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/tendênciasRESUMO
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the surgical treatment of choice for morbid obesity. Several therapeutic options to remove common bile duct (CBD) stones have been proposed in these patients. Laparoscopy-assisted transgastric ERCP (LATERCP) has a high success rate. However, the procedure is not fully standardized and some technical variations have been proposed. We introduce two cases in which laparoscopic transgastric ERCP has been used to treat choledocholithiasis after LRYGB.
Assuntos
Cirurgia Bariátrica , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Esfinterotomia EndoscópicaRESUMO
BACKGROUND AND AIM: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. METHODS: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. RESULTS: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. CONCLUSIONS: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention.
Assuntos
Adenoma/cirurgia , Ampola Hepatopancreática/cirurgia , Neoplasias do Ducto Colédoco/cirurgia , Endoscopia Gastrointestinal/métodos , Endoscopia Gastrointestinal/efeitos adversos , HumanosRESUMO
Background and aim: This article provides a practical review to undertaking safe endoscopic ampullectomy and highlights some of the common difficulties with this technique as well as offering strategies to deal with these challenges. Methods: We conducted a review of studies regarding endoscopic ampullectomy for ampullary neoplasms with special focus on techniques. Results: Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. The optimal technique for endoscopic ampullectomy is dependent on the lesions size. En bloc resection is recommended for lesions confined to the papilla. There is no significant evidence to support the submucosal injection before ampullectomy. There is no consensus regarding the optimal current and power output for endoscopic ampulectomy. The benefits of a thermal adjunctive therapy remain controversial. A prophylactic pancreatic stent reduces the incidence and severity of pancreatitis post-ampullectomy. Conclusions: Endoscopic ampullectomy is a safe and efficacious therapeutic procedure for papillary adenomas in experienced endoscopist and it can avoid the need for surgical intervention (AU)
No disponible
Assuntos
Humanos , Masculino , Feminino , Adenocarcinoma Papilar/cirurgia , Adenocarcinoma Papilar , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Ampola Hepatopancreática , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endoscopia/métodos , Endoscopia/normas , Endoscopia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Procedimentos Cirúrgicos do Sistema Digestório , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias dos Ductos Biliares , Ductos Biliares/patologia , Ductos BiliaresRESUMO
A 64 year-old male, was diagnosed with obstructive jaundice due to a well-differentiated pancreatic neuroendocrine tumor with liver metastases. The patient underwent endoscopic placement of covered self-expanding biliary stent (10x60 mm, Hanaro) by ERCP. He was admitted with cholangitis one year later. The following ERCP revealed a fractured stent with loss of the distal end (duodenal) and partial migration of the remaining stent to the common bile duct. The fragmented stent was removed from the common bile duct and a new, similar one was inserted. Four months later the patient was admitted with cholangitis. A new ERCP was done and biliary stent was also fragmented. It was removed and an uncovered stent (Wallflex) was inserted.
Assuntos
Ductos Biliares , Falha de Prótese , Stents/efeitos adversos , Remoção de Dispositivo , Humanos , Icterícia Obstrutiva/cirurgia , Masculino , Pessoa de Meia-Idade , Implantação de PróteseRESUMO
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Assuntos
Humanos , Masculino , Criança , Stents Farmacológicos/tendências , Stents Farmacológicos , Icterícia Obstrutiva/diagnóstico , Icterícia Obstrutiva/cirurgia , Icterícia Obstrutiva , Stents/efeitos adversos , Stents Metálicos Autoexpansíveis/efeitos adversos , Stents Metálicos Autoexpansíveis , Endoscopia/métodos , Endoscopia , Colangite/complicações , Colangite/cirurgia , Colangite , CorrosãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso , Nódulo da Irmã Maria José/complicações , Nódulo da Irmã Maria José/diagnóstico , Nódulo da Irmã Maria José/patologia , Gastroscopia/métodos , Biomarcadores Tumorais/análise , Gastrectomia , Vômito/complicações , Adenocarcinoma/complicações , Adenocarcinoma , Metástase Neoplásica/patologia , Metástase Neoplásica , PrognósticoRESUMO
Different treatment modalities have been proposed in the treatment of early gastric cancer (EGC). Endoscopic resection (ER) is an established treatment that allows curative treatment, in selected cases. In addition, ER allows for an accurate histological staging, which is crucial when deciding on the best treatment option for EGC. Recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have become alternatives to surgery in early gastric cancer, mainly in Asian countries. Patients with "standard" criteria can be successfully treated by EMR techniques. Those who meet "expanded" criteria may benefit from treatment by ESD, reducing the need for surgery. Standardized ESD training system is imperative to promulgate effective and safe ESD technique to practices with limited expertise. Although endoscopic resection is an option in patients with EGC, surgical treatment continues to be a widespread therapeutic option worldwide. In this review we tried to point out the treatment modalities for early gastric cancer.
RESUMO
Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented.
RESUMO
Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.
