Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up.
BACKGROUND: Gastro-oesophageal reflux disease (GORD) is, in the main, treated with either proton pump inhibitor (PPI) drugs or a Nissen fundoplication operation. Recently, BARD developed Endocinch, a device used to place sutures just below the oesophagogastric junction (OGJ) to treat GORD. AIM: To evaluate the long term benefit of the Endocinch technique in patients seen up to 12 months post procedure. PATIENTS: Twenty six patients with symptoms of GORD were recruited and had the procedure performed. Four patients were lost to follow up. METHODS: Twenty two patients completed their one year follow up. Pre procedure and post procedure (up to 12 months) assessments included symptom scoring (DeMeester), upper intestinal endoscopy, oesophageal manometry and 24 hour oesophageal pH, and completion of quality of life (QOL) questionnaires. RESULTS: Mean age was 39 years (range 22-62). Heartburn symptom score was reduced from a mean value of 19.22 at baseline to 7.5 at 12 months (n=22) (p<0.0001). Regurgitation score reduced from a mean of 2.27 at baseline to 0.86 at 12 months (n=22) (p<0.001). Mean (SEM) pH DeMeester acid score was reduced from 44.1 (4.3) to 33.32 (4.73) (p=0.028) at three month post procedure. Percentage upright acid exposure and number of reflux episodes were also reduced significantly. Use of PPIs was reduced by 64% at 12 months post procedure. All QOL assessments showed significant improvement (p=0.01). All transient post procedure complaints resolved within 72 hours. CONCLUSION: The Endocinch procedure is an effective and safe outpatient procedure that offers GORD patients significant improvement in symptomatology, QOL, and reduced requirements for PPIs over at least a one year period. (+info)
Double endoscopic intraluminal operation for upper digestive tract diseases: proposal of a novel procedure.
BACKGROUND AND OBJECTIVE: Endoscopic treatment of digestive tract diseases, such as early esophageal and gastric neoplasia, has become increasingly popular in recent years as an alternative to surgical procedures in the hope of providing an improved quality of life for these patients. However, one of the limitations of a conventional endoscopic mucosal resection, such as an aspiration mucosectomy and a strip biopsy, has been the size of the lesions to be resected. Both an aspiration mucosectomy and strip biopsy are useful variants for removing flat lesions measuring less than 20 mm in maximal diameter. To overcome such limitations, we devised a double endoscopic intraluminal operation (DEILO), which enables us to resect mucosal lesions by using 2 fine endoscopes and monopolar shears. METHODS: DEILO was performed on patients with esophageal and gastric lesions measuring up to 40 mm in diameter. This novel technique is characterized by the use of 2 endoscopes (one for lifting the lesion and the other for cutting the lesions) inserted into the esophagus or stomach through an overtube. A mucosal resection is then performed by dissecting the mucosal margin with newly developed monopolar shears, thereby separating the mucosa from the submucosa. RESULTS: A total of 25 lesions in the esophagus (8 lesions) and stomach (17 lesions) were resected by DEILO. The sizes of the esophageal lesions ranged from 8 to 40 mm in diameter (mean, 21.1 mm) whereas gastric lesions ranged from 8 to 30 mm (mean, 13.3 mm) in diameter, and histopathologic examinations revealed the resection margin to be clear and without any tumor. No complications or instances of recurrence were observed in this series. CONCLUSIONS: DEILO is considered to be feasible for the mucosal resection of esophageal and gastric lesions measuring more than 10 mm in diameter without submucosal invasion, whereas conventional endoscopic mucosal resection is indicated for such lesions measuring less than 10 mm in size. (+info)
Endoscopic retrieval of multiple fragmented gastric bamboo chopsticks by using a flexible overtube.
This is a rare case of a patient with mental disorder, who ingested nineteen pieces of fragmented bamboo chopsticks. We managed the multiple gastric foreign bodies with a sclerotherapy overtube, and these multiple fragmented bamboo chopsticks were retrieved successfully using the endoscopic method. There were only multiple erosions with hemorrhage over the mucosa of fundus and body of stomach, no fragments adhered or perforated through the gastric wall. The mucosa of esophagus was intact. The patient tolerated the procedure well and without any major complications. Multiple sharp elongated gastric foreign bodies can be successfully and safely retrieved by using protective sheath of oropharynx without assistance with laparoscopy or surgical intervention. This renders an option for the endoscopists to manage multiple elongated gastric foreign bodies. (+info)
Results of gastroscope bacterial decontamination by enzymatic detergent compared to chlorhexidine.
AIM: To compare the efficacy of enzymatic detergent with chlorhexidine for gastroscope bacterial decontamination. METHODS: A prospective randomized controlled study was undertaken to evaluate the ability of these 2 agents to achieve high level disinfection in a gastroscope. A total of 260 samples were collected from 5 different gastroscopes. Manual cleaning was done for 10 min with these 2 agents separately (n = 130 each). Then all specimens underwent 2% glutaraldehyde soaking for 20 min. After 70% alcohol was rinsed, sterile normal saline was flushed into each gastroscope channel and 40 mL of sample was collected. The sample was sent for aerobic bacterial culture after membrane was filtered. A colony count greater than 200 cfu/mL was considered significant. RESULTS: The positive culture rate was 4.6% in the enzymatic detergent arm and 3.1% in the chlorhexidine arm. Pseudomonas species were the main organism detected from both groups (60%). Multiple organisms were found from 4 specimens (enzymatic detergent arm = 1, chlorhexidine arm = 3). CONCLUSION: The contamination rate of both types of cleaning solution is equivalent. (+info)
Elastic band ligation of hemorrhoids: flexible gastroscope or rigid proctoscope?
AIM: To compare rigid proctoscope and flexible endoscope for elastic band ligation of internal hemorrhoids. METHODS: Patients between 18 and 80 years old, with chronic complaints (blood loss, pain, itching or prolapse) of internal hemorrhoids of grade 1-3, were randomized to elastic band ligation by rigid proctoscope or flexible endoscope (preloaded with 7 bands). Patients were re-treated every 6 wk until the cessation of complaints. Evaluation by three-dimensional anal endosonography was performed. RESULTS: Forty-one patients were included (median age 52.0, range 27-79 years, 20 men). Nineteen patients were treated with a rigid proctoscope and twenty two with a flexible endoscope. Twenty-nine patients had grade 1 hemorrhoids, 9 patients had grade 2 hemorrhoids and 3 patients had grade 3 hemorrhoids. All patients needed a minimum of 1 treatment and a maximum of 3 treatments. A median of 4.0 bands was used in the rigid proctoscope group and a median of 6.0 bands was used in the flexible endoscope group (P < 0.05). Pain after ligation tended to be more frequent in patients treated with the flexible endoscope (first treatment: 3 vs 10 patients, P < 0.05). Three-dimensional endosonography showed no sphincter defects or alterations in submucosal thickness. CONCLUSION: Both techniques are easy to perform, well tolerated and have a good and fast effect. It is easier to perform more ligations with the flexible endoscope. Additional advantages of the flexible scope are the maneuverability and photographic documentation. However, treatment with the flexible endoscope might be more painful and is more expensive. (+info)
Colorectal tumors with complete obstruction--endoscopic recovery of passage replacing emergency surgery? A report of two cases.
BACKGROUND: Incomplete or complete obstructive ileus due to colorectal cancer is generally treated by emergency surgery that has higher morbidity and mortality than elective surgery. CASE PRESENTATION: Here we describe an endoscopic technique by which a safe bowel decompression was performed instead of emergency surgery in two patients with complete tumorous obstruction of the colon. By means of a polypectomy snare, a soft wire, an ERCP catheter, a set of endoscopes with different diameters (baby endoscope, gastroscope) and of argon plasma coagulation the tumor mass was reduced and the tumor stenosis was passed. The patients recovered from symptoms of colon obstruction, no procedure-associated complications were observed. One patient had surgery of the sigmoid tumor one week later (UICC-stage III), the other patient (UICC-stage IV) received systemic chemotherapy starting one week after endoscopic decompression. CONCLUSION: Complete tumorous obstruction of the colon may be managed by endoscopic tumor debulking avoiding high risk emergency surgery and allowing immediate medical treatment of the primary tumor and of metastases. (+info)
Percutaneous endoscopic gastrostomy in the supermorbidly obese patient.
INTRODUCTION: Obesity is reaching epidemic proportions in the United States, and as patients at the extremes of morbid obesity come under the care of surgeons, routine procedures may become increasingly complex in the face of greater body mass. We prospectively evaluated the success rate of percutaneous endoscopic gastrostomy (PEG) placement in a group of morbidly obese patients outside the current classification systems used to stratify obesity. METHODS: Patients with a body mass index (BMI) greater than 60 kg/m2 who presented for PEG over a one year period were prospectively enrolled. Each patient underwent attempted PEG placement using the pull method by a single surgeon. Outcome variables included: successful PEG, wound infection, tube dislodgement, or bleeding. RESULTS: Six patients with BMI > 60 kg/m2 presented for PEG. All patients were in a surgical critical care unit maintained on mechanical ventilation. All underwent successful PEG placement with standard techniques and sustained no post-procedural complications. CONCLUSION: In the hands of an experienced surgical endoscopist, percutaneous endoscopic gastrostomy can be safely performed in patients at the extremes of morbid obesity. Future studies are warranted to validate the results of our small series. (+info)
The Sengstaken-Blakemore tube: uses and abuses.
Due to its complications including oesophageal and gastric ulceration and perforation, the Sengstaken-Blakemore tube is used far less commonly in this new millennium where endoscopic intervention is available. We discuss in a 53-year-old Indian woman an unusual life-saving use of the Sengstaken-Blakemore tube in preventing fatal exsanguination from an aortoesophageal fistula, as well as rare but devastating consequences of the insertion and residence of the Sengstaken-Blakemore tube, including acute airway obstruction and bronchoesophageal fistula. (+info)