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Binmoeller KF. EUS instruments for esophageal lesions. Endoscopy 1998; 30 Suppl 1:A26-7. [PMID: 9765079 DOI: 10.1055/s-2007-1001461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Bohnacker S, Thonke F, Hinner M, Seitz U, Binmoeller KF, Brand B, Rathod VD, Soehendra N. Improved endoscopic stenting for malignant dysphagia using Tygon plastic prostheses. Endoscopy 1998; 30:524-31. [PMID: 9746160 DOI: 10.1055/s-2007-1001338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic palliative treatment of malignant esophageal stenosis using conventional plastic stents has been reported to be associated with a considerable risk of perforation. Stenoses with a distance of less than 2cm from the upper esophageal sphincter (UES) have generally been excluded from treatment. Using self-expandable metal stents, procedure-related complications are rare. However, the rates of late complications necessitating retreatment appear to be as high as those of plastic stents. This study describes our stent placement technique and our results using a modified Tygon plastic stent. PATIENTS AND METHODS Over a two-year period, 71 consecutive patients with incurable malignant esophageal stenosis were prospectively studied. Tygon plastic stents of diameter 9-14 mm were individually tailored according to length and location of the stenosis. Prior to stenting, stepwise bougienage was performed, if necessary over several sessions. After endoscopic placement of a guide wire, the stent was inserted over a bougie without fluoroscopic monitoring. RESULTS A total of 71 patients (54 men and 17 women, median age 69, range 34-93), were treated with Tygon plastic stents (14 mm: 19 patients; 12 mm: 50 patients; 9 mm: 2 patients). Median length of the strictures and of the stents were 7 (range 2-18) and 10 (range 6-25) cm, respectively. Four patients had an associated esophago-respiratory fistula. After a median of 2 (range 1-5) bougienage sessions, stent insertion was technically successful in all patients. Forty-one stents were placed across the cardia, 13 were positioned 0.5-1 cm below the UES. Three patients had to undergo retreatment within 24 hours because of pain or stent migration and the stents were repositioned or exchanged. No procedure-related perforation, hemorrhage or respiratory problems were observed. During a median follow-up of 63 (range 2-388) days, 82% of the patients died. Improvement or stabilization of dysphagia allowing for oral nutrition could be achieved in 89%. Dislocation occurred in eight patients, bolus obstruction in five patients and tumor overgrowth in four patients. Three of the four fistulas could be covered by the stent. In one patient with a fistula located at the level of the UES, a stent was placed but migrated after 5 days. Overall, 27 patients (38%) required reinterventions, mainly for dysphagia or nutritional problems. CONCLUSIONS In our experience, Tygon plastic stents with a diameter of 9-14 mm can be safely placed after stepwise, less extensive bougienage. Effective palliation is possible even for lesions located close to the UES. Perforation can be avoided. Reintervention rates seem to be comparable to those seen with self-expanding metal stents.
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Binmoeller KF, Brand B, Thul R, Rathod V, Soehendra N. EUS-guided, fine-needle aspiration biopsy using a new mechanical scanning puncture echoendoscope. Gastrointest Endosc 1998; 47:335-40. [PMID: 9609423 DOI: 10.1016/s0016-5107(98)70215-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND A new mechanical sector scanning echoendoscope designed for EUS-guided, fine-needle aspiration biopsy (FNAB) was prospectively evaluated. The technical feasibility, safety, and histocytologic FNAB results are reported. METHODS Eighty-six patients underwent 106 FNAB procedures. The new echoendoscope has a 2.8 mm accessory channel and an elevator. Target sites: pancreas 58, lymph nodes 43, and miscellaneous lesions 5. Lesions were punctured with a 0.7 mm needle and submitted for cytologic and histologic examination. Definitive diagnosis was by surgery or clinical follow-up. RESULTS The wide scanning field (250 degrees) enabled easy sonographic orientation for FNAB. Longitudinal needle visibility was "good" in 93% and 71% of transesophageal and transgastric procedures, respectively, but were compromised during most transduodenal procedures. Needle penetration of indurated pancreatic lesions failed in two patients, and in four additional patients pancreatic sampling succeeded only after a second attempt using an automated spring-loaded device. The mean number of passes was three. Ten percent of FNAB specimens were "inadequate"; excluding these, the diagnostic accuracy rate was 97%; sensitivity for malignancy was 88.5% and specificity was 100%. CONCLUSION EUS-guided FNAB is feasible, safe, and accurate using the new mechanical puncture echoendoscope. Needle visibility needs to be improved, particularly for transduodenal FNAB.
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Binmoeller KF, Date S, Soehendra N. Treatment of esophagogastric varices: endoscopic, radiological, and pharmacological options. Endoscopy 1998; 30:105-13. [PMID: 9592651 DOI: 10.1055/s-2007-1001236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Binmoeller KF, Thul R, Rathod V, Henke P, Brand B, Jabusch HC, Soehendra N. Endoscopic ultrasound-guided, 18-gauge, fine needle aspiration biopsy of the pancreas using a 2.8 mm channel convex array echoendoscope. Gastrointest Endosc 1998; 47:121-7. [PMID: 9512275 DOI: 10.1016/s0016-5107(98)70343-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have reported on endoscopic ultrasound-guided, fine needle aspiration biopsy using 22- to 25-gauge needles. We evaluated the histologic and cytologic yield of endoscopic ultrasound-guided, fine needle aspiration biopsy of the pancreas using an 18-gauge, Menghini-type core needle. METHODS Fine needle aspiration biopsy was performed in conjunction with a prototype 2.8 mm channel convex array echoendoscope. The core specimen was placed in formalin for cell block, and residual material was expelled on slides for cytology. Definitive diagnosis was established by surgery or clinical follow-up. RESULTS Of 45 patients who underwent fine needle aspiration biopsy, the needle failed to penetrate indurated pancreatic lesions in five. An average of 2.6 passes were performed in the remaining patients. Sufficient material for a histologic and/or cytologic diagnosis was obtained in 40 patients (histologic and cytologic yield of 68% and 75%, respectively). Combining the results of histology and cytology, the sensitivity and specificity for detection of malignancy was 76% and 100%, respectively. Histology confirmed the cytologic findings in 35 patients, providing additional tissue specific information. In three cases histology established a diagnosis of malignancy where cytology was not conclusively malignant. However, in three cases of surgically confirmed malignancy histology failed to detect malignancy, whereas cytology showed suspicious or malignant cells. The sensitivity of histology and cytology alone in detecting malignancy was 53% and 70%, respectively. Mild pancreatitis occurred after pancreatic fine needle aspiration biopsy in one patient. CONCLUSION Core specimens for histology can be safely obtained using an 18-gauge needle. Histology provides tissue-specific information that complements cytology, but histology is less sensitive than cytology in detecting malignancy.
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Binmoeller KF, Rathod VD, Soehendra N. Endoscopic therapy of pancreatic strictures. Gastrointest Endosc Clin N Am 1998; 8:125-42. [PMID: 9405755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the past decade, endoscopic therapy has been increasingly used as a less invasive alternative to surgery for the treatment of pancreatic duct strictures. The therapeutic goal has been the palliative relief of severe pain associated with chronic pancreatitis. Studies from several centers have shown that endoscopic stenting results in pain relief for a high percentage of patients. Future investigation needs to focus on the refinement and standardization of basic techniques, and different strategies need to be compared in well-designed trials.
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Soehendra N, Bohnacker S, Binmoeller KF. Nonvariceal upper gastrointestinal bleeding. New and alternative hemostatic techniques. Gastrointest Endosc Clin N Am 1997; 7:641-56. [PMID: 9376955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In upper gastrointestinal bleeding, endoscopic management does reduce rates of rebleeding, surgery, and mortality. In active bleeding, however, early recurrence still occurs in around 20% despite successful initial hemostasis. Several new techniques or modifications of endoscopic hemostatic methods have been invented to improve the results. They include ligating devices, biological injection agents, argon plasma coagulation, and hemoclips. Hemoclips and injection therapy using fibrin glue do not cause relevant tissue damage and appear to have better results in terms of lower rebleeding rates. Fibrin glue seems to be effective only if injected repeatedly. Due to limited experience, no final conclusion can be made at this stage. Further clinical investigation is warranted.
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Wang YG, Binmoeller KF, Li ZL, Soehendra N. Endoscopic haemoclip ligation of pedunculated polyp before polypectomy. World J Gastroenterol 1997; 3:200. [PMID: 27239157 PMCID: PMC4842898 DOI: 10.3748/wjg.v3.i3.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/1996] [Revised: 05/13/1996] [Accepted: 06/11/1997] [Indexed: 02/06/2023] Open
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Binmoeller KF, Jabusch HC, Seifert H, Soehendra N. Endosonography-guided fine-needle biopsy of indurated pancreatic lesions using an automated biopsy device. Endoscopy 1997; 29:384-8. [PMID: 9270920 DOI: 10.1055/s-2007-1004220] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND STUDY AIMS We have designed and evaluated a prototype automated spring-loaded biopsy needle for endoscopic ultrasonography (EUS)-guided tissue sampling of indurated lesions in which sampling using conventional aspiration needles has failed. PATIENTS AND METHODS EUS-guided fine-needle biopsy using the new device was performed in four patients (two men, two women, mean age 65 years) with indurated pancreatic lesions that could not be penetrated with a conventional manually operated aspiration needle. The lesions were located in the head of the pancreas in two patients, in the genu in one, and in the body in one. RESULTS The automatic biopsy needle allowed penetration of the pancreatic lesions in all cases. The biopsy route was transduodenal in two patients, and transgastric in the other two. The biopsies provided a core specimen for histological and cytological diagnosis in all cases. No complications occurred. CONCLUSION The spring-loaded biopsy needle allows tissue sampling of indurated pancreatic lesions that cannot be penetrated with conventional aspiration needles. Further studies are warranted to determine whether this device can improve the results of EUS-guided fine-needle aspiration biopsy.
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Soehendra N, Binmoeller KF, Bohnacker S, Seitz U, Brand B, Thonke F, Gurakuqi G. Endoscopic snare mucosectomy in the esophagus without any additional equipment: a simple technique for resection of flat early cancer. Endoscopy 1997; 29:380-3. [PMID: 9270919 DOI: 10.1055/s-2007-1004219] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic mucosal resection of early esophageal cancer has increasingly proved to be an effective treatment modality, especially if the tumor has not invaded the muscularis mucosae. Different techniques have been introduced, using an overtube, double-channel endoscope, or suction cap. We have not found that these devices are required for snare resection in the esophagus. PATIENTS AND METHODS Over a period of two years (1994-1996), seven patients (five men and two women, age range 59-88) with early esophageal cancer defined by endosonography (3 cm or less in size, limited to the submucosal layer) were treated using a simplified technique of endoscopic snare resection using a monopolar diathermic polypectomy snare made of monofilament steel wire. The snare was positioned around the lesion, and then closed while pressing the snare against the mucosa and applying suction to draw the lesion into the snare. Pure coagulation current was used for resection. If necessary, a piecemeal technique was used to achieve complete removal. RESULTS Complete removal was achieved in one session in all seven cases. No complications were observed. Two patients underwent radical surgery with no tumor remnant or metastatic lymph node in the resected specimen. All patients have remained free of recurrence during a median follow-up period of seven months (range 3-22 months). Two patients died of cardiovascular disease four and eight months after endoscopic mucosal resection. CONCLUSION Small early esophageal cancer can be safely removed with a simplified method of endoscopic snare resection using a standard monofilament polypectomy snare.
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Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Soehendra N, Broelsch CE. [Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study]. Chirurg 1997; 68:369-77. [PMID: 9206631 DOI: 10.1007/s001040050200] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Beger and Frey combine both to different degrees. In a prospective randomized trial both procedures were compared: 74 patients were randomly allocated to either Beger's (n = 38) or Frey's, (n = 36) group. In addition to routine pancreatic diagnostic work-up a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The mean interval between symptoms and surgery was 5.1 years (1-12 years). The median follow-up was 30 months. There was no mortality. Overall morbidity was 27% (32% Beger, 22% Frey). Complications from adjacent organs were definitively resolved in 91% (92% Beger, 91% Frey). A decrease in pain score of 95% and 93% after Beger's and Frey's procedure, respectively, and an increase of 67% in the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between the two groups. Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.
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Bloechle C, Busch C, Tesch C, Nicolas V, Binmoeller KF, Soehendra N, Izbicki JR. Prospective randomized study of drainage and resection on non-occlusive segmental portal hypertension in chronic pancreatitis. Br J Surg 1997; 84:477-82. [PMID: 9112896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In chronic pancreatitis, compression of the splenic vein and superior mesenteric vein (SMV) by an inflammatory mass may cause segmental portal hypertension. Drainage and resection are the principles of surgery for chronic pancreatitis. This study was devised to evaluate the effect of drainage and resection on venous splanchnic blood flow in patients with non-occlusive segmental portal hypertension. METHODS In 14 of 30 patients with chronic pancreatitis predominantly involving the pancreatic head, segmental portal hypertension due to compression of the splenic vein and SMV was detected by means of indirect splenomesentericoportography and Doppler ultrasonography. None of these 14 patients had symptomatic gastric fundic varices. They were allocated randomly to surgical drainage or resection. Median follow-up was 30 (range 12-48) months. RESULTS In the resection group, mean(s.d.) splenic vein blood flow increased from 316(46) ml/min before operation to 396(57) ml/min at follow-up (P < 0.01). In the drainage group, preoperative splenic vein blood flow (318(37) ml/min) was not increased after operation (322(37) ml/min). Mean(s.d.) SMV flow increased from 292(42) ml/min before operation to 436(64) ml/min at follow-up (P < 0.01) in the resection group. In the drainage group mean(s.d.) SMV blood flow was 296(32) ml/min before operation and 314(34) ml/min at follow-up. No patient developed fundic gastric varices during follow-up. CONCLUSION In non-occlusive segmental portal hypertension due to chronic pancreatitis, resection, but not drainage, restores normal venous splanchnic blood flow.
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Binmoeller KF, Krug C, Rehner M, Seifert H, Soehendra N. [Endoscopic prosthesis implantation in stenoses and fistulas of the proximal cervical esophagus]. Zentralbl Chir 1997; 122:44-8. [PMID: 9133136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic placement of an esophageal prosthesis is a well established palliative treatment for esophageal carcinoma. However, the treatment of high cervical tumors using commercially available plastic prostheses is problematic. We modified the design and implantation techniques of the Celestin prosthesis to accommodate high cervical tumors and report our results in 38 patients. Over a 7 year period 42 modified Celestin prostheses were implanted in 38 patients with high cervical esophageal tumors. 15 had stenosis only, 22 had a stenosis and fistula, and one had a fistula without stenosis. Graduated bouginage up to 38 Fr or 42 Fr for large prostheses was performed prior to stent placement in an average of 2.3 sessions. There were no procedure-related complications. Only in one case the prosthesis had to be withdrawn after reimplantation because of intolerable painful foreign body sensation. Improvement of dysphagia was achieved in 34 patients. The fistulas could be adequately bridged and sealed in 17 of 23 patients. Prostheses migrated in 11 cases (proximally, n = 6; distally, n = 5). Mean patient survival in 28 patients followed until death was 86 days (range 5-338 days).
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Binmoeller KF, Seifert H, Gerke H, Seitz U, Portis M, Soehendra N. Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation. Gastrointest Endosc 1996; 44:689-95. [PMID: 8979059 DOI: 10.1016/s0016-5107(96)70053-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. PATIENTS AND METHODS Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. RESULTS Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05). CONCLUSION Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.
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Bohnacker S, Thonke F, Binmoeller KF, Soehendra N. [Hemostasis with the endoscope]. Internist (Berl) 1996; 37:817-22. [PMID: 8964673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Binmoeller KF, Bohnacker S, Seifert H, Thonke F, Valdeyar H, Soehendra N. Endoscopic snare excision of "giant" colorectal polyps. Gastrointest Endosc 1996; 43:183-8. [PMID: 8857131 DOI: 10.1016/s0016-5107(96)70313-9] [Citation(s) in RCA: 173] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic treatment of giant colorectal polyps remains controversial because of concerns regarding coexistent malignancy, incomplete resection, and safety. METHODS We reviewed the clinical course after removal of 176 benign-appearing large (>3 cm) colorectal polyps, which were removed by endoscopic snare resection in 170 patients. These were termed "giant" polyps. Sessile polyps (n = 129) were removed piecemeal and pedunculated polyps (n = 47) transected at the stalk. RESULTS Bleeding was the only complication in 24% of polypectomy procedures (procedural in 58, immediate in 3, delayed in 6 patients). Except for one conservatively treated delayed bleed, all bleeds were treated endoscopically. Histology of resected polyps showed coexistent malignancy in 12%. Eight patients had malignant polyps that met "unfavorable" criteria and underwent surgery. Following complete endoscopic resection, 16 patients were lost to follow-up and 124 patients had follow-up of at least 6 months (117 benign and 7 "favorable" malignant polyps). Nineteen patients with benign polyps developed recurrences (18 benign, 1 malignant); one patient with a favorable malignant polyp had a malignant recurrence and underwent surgery. CONCLUSION Endoscopic resection of benign-appearing giant colorectal polyps is feasible and safe. Complete excision is possible in patients with benign and favorable malignant polyps, but recurrence rates are high. Close surveillance to detect and treat recurrence is required.
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Wang YG, Binmoeller KF, Seifert H, Maydeo A, Soehendra N. A new guide wire papillotome for patients with Billroth II gastrectomy. Endoscopy 1996; 28:254-5. [PMID: 8739743 DOI: 10.1055/s-2007-1005438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND STUDY AIMS Guide wire-assisted papillotomy is a well-established technique in conventional biliary endoscopy, but has not been previously employed in Billroth II patients, due to the lack of an appropriate papillotome that can accommodate a guide wire. We therefore designed a Billroth II papillotome that can be inserted over a guide wire. PATIENTS AND METHODS Over a 12-month period, 24 patients (18 males, six females, median age 72 years), who had previously undergone a Billroth II gastrectomy and who were referred to our department for therapeutic biliary endoscopic procedures, were included in this study. RESULTS The papilla could be reached in 22 patients, but the procedure failed in two due to an excessively long afferent loop. Cannulation of the bile duct with the standard Billroth II papillotome was possible in 11 patients; the remaining 11 patients, in whom free cannulation failed, underwent cannulation over the guide wire. Diagnostic endoscopic retrograde cholangiography revealed bile duct stones in 17 patients, and malignant-appearing common bile duct stenoses in five patients. Papillotomy was successfully performed using the guide wire Billroth II papillotome in all patients, without complications. CONCLUSION The Billroth II papillotome is effective and safe in patients in whom free cannulation has failed using the standard Billroth II papillotome.
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Binmoeller KF, Jue P, Seifert H, Nam WC, Izbicki J, Soehendra N. Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results. Endoscopy 1995; 27:638-44. [PMID: 8903975 DOI: 10.1055/s-2007-1005780] [Citation(s) in RCA: 205] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Endoscopic pancreatic stent drainage has been reported to relieve pain due to chronic pancreatitis in patients with ductal outflow obstruction. However, data regarding the long-term results, as presented here, have hitherto been lacking. PATIENTS AND METHODS Over a nine-year period, 93 patients (65 males, mean age 49 years) with narcotic-dependent pain due to chronic pancreatitis and with a dominant pancreatic duct stricture visualized by endoscopic retrograde cholangiopancreatography (ERCP), were treated by stent drainage. The duration of pain prior to treatment averaged 5.6 years. The stents were exchanged according to symptoms, and removed if the stricture was judged to be adequately dilated after stenting. RESULTS Sixty-nine patients (74%) reported complete (n = 46) or partial (n = 23) pain relief at six months. In this group of "early responders", 60 patients experienced sustained improvement during a mean follow-up of 4.9 years (nine had recurrent pain after a mean of 1.2 years). Stents were removed in 49 patients after a mean of 15.7 months; during a mean follow-up of 3.8 years, 36 patients remained pain-free, and 13 had a relapse of pain (11 were retreated by endoscopic drainage and subsequently became pain-free). Complications seen included mild pancreatitis (n = 4) and abscess formation secondary to stent clogging (n = 2). Most patients experienced a regression of the ductal dilation after stenting. CONCLUSION In selected patients, early responders to pancreatic stent drainage are likely to benefit over the long term. Stent removal after stricture dilation may be associated with continued pain relief.
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Binmoeller KF, Soehendra N. Nonsurgical treatment of variceal bleeding: new modalities. Am J Gastroenterol 1995; 90:1923-31. [PMID: 7484993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Binmoeller KF, Seitz U, Seifert H, Thonke F, Sikka S, Soehendra N. The Tannenbaum stent: a new plastic biliary stent without side holes. Am J Gastroenterol 1995; 90:1764-8. [PMID: 7572890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Clogging of plastic biliary stents used in malignant biliary obstruction remains a major problem. In vitro studies have shown that side holes, a standard feature of commercially available stents, may contribute to stent clogging. In a pilot study, we designed and prospectively evaluated a new biliary stent without side holes (Tannenbaum stent). METHODS Over a 12-month period, 55 consecutive patients (mean age 75 yr) with malignant distal common bile duct obstruction and without papillary or duodenal tumor infiltration underwent endoscopic placement of the Tannenbaum stent for the palliative treatment of jaundice. RESULTS Tannenbaum stent insertion was technically successful on the first attempt in all patients and was accompanied by a significant reduction in mean serum bilirubin levels (10.1-1.6 mg%). Fifty-one patients were followed until death (median survival of 130 days); the symptomatic occlusion rate was 16%, the dislocation rate was 8%, and the median stent patency was 64 wk. Aside from stent clogging, there were no complications. CONCLUSION The Tannenbaum stent provided effective palliative biliary decompression in all patients. The patency rate was longer than that reported in the literature for conventional plastic stents with side holes and compared favorably with patency rates that have been reported for the metallic expandable biliary stents. The results of this pilot study are encouraging and warrant further studies.
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Binmoeller KF, Soehendra N. Endoscopic ultrasonography in the diagnosis and treatment of pancreatic pseudocysts. Gastrointest Endosc Clin N Am 1995; 5:805-16. [PMID: 8535629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This article reviews the current diagnostic and therapeutic modalities used in pseudocyst drainage and possible contributions of endoscopic ultrasound to this process. The authors conclude that EUS should improve the ability to reliably differentiate pseudocysts from cystic neoplasms and are excited about the new development that proposes to combine therapy with diagnosis.
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Binmoeller KF, Seifert H, Walter A, Soehendra N. Transpapillary and transmural drainage of pancreatic pseudocysts. Gastrointest Endosc 1995; 42:219-24. [PMID: 7498686 DOI: 10.1016/s0016-5107(95)70095-1] [Citation(s) in RCA: 240] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Endoscopic drainage of pseudocysts using the transpapillary and transmural approaches has been reported. We evaluated endoscopic drainage in 53 patients with symptomatic pancreatic pseudocysts in whom conservative management had failed. METHODS After preliminary endoscopic retrograde pancreatography, transpapillary drainage was attempted in 33 patients with pseudocysts that communicated with the main pancreatic duct. Transmural drainage of pseudocysts in contact with the stomach or duodenal wall was attempted in the remaining 20 patients and in 4 patients selected for combined transpapillary and transmural drainage. The cause of pseudocysts was chronic pancreatitis in 92%. The median pseudocyst size was 7.0 cm (range, 2 to 16). RESULTS Endoscopic drainage was technically successful in 50 patients (94%), of whom 47 had complete pseudocyst resolution. Complications occurred in 11% and included gallbladder puncture (n = 1) and bleeding (n = 2) after transmural drainage, and pancreatitis (n = 1) after transpapillary drainage; stent clogging resulted in abscess formation in 2 patients. Mean follow-up was 22 months (range, 1 to 70); pseudocysts recurred in 11 patients (23%), of whom 7 were successfully re-treated endoscopically. CONCLUSION Both transpapillary and transmural pseudocyst drainage are highly effective in patients with pseudocysts demonstrating suitable anatomy for these endoscopic techniques.
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Binmoeller KF, Seifert H, Seitz U, Izbicki JR, Kida M, Soehendra N. Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma. Gastrointest Endosc 1995; 41:547-52. [PMID: 7672546 DOI: 10.1016/s0016-5107(95)70188-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas. METHODS Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire). RESULTS The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively. CONCLUSIONS The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.
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Seifert H, Binmoeller KF, Soehendra N. [Pancreatic pseudocysts: how and when should they be drained?]. BILDGEBUNG = IMAGING 1995; 62 Suppl 1:12-18. [PMID: 7670295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Of 93 endoscopic drainage procedures of pancreatic pseudocysts carried out since 1985, at least 50% were of lasting success. The authors' approach is explained with a review of the literature on various drainage techniques. We consider the puncture of a pseudocyst justified only on clinical grounds: the patient's complaints rather than morphological criteria lead to the decision to perform a drainage procedure. Obligatory in the therapeutic concept are ERCP and endosonography. Visualization of a pancreatico-cystic communication leads to the attempt of transpapillary drainage as the therapy of choice. Visualization of anatomic details, namely vessels, lowers the risk of punctures. Direct punctures even in difficult anatomical conditions can be attempted under direct endosonographic control. In our hands, drainage of pseudocysts is a part of the endoscopic treatment concept for chronic pancreatitis and is generally preferred to surgical techniques.
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Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Ann Surg 1995; 221:350-8. [PMID: 7726670 PMCID: PMC1234583 DOI: 10.1097/00000658-199504000-00004] [Citation(s) in RCA: 230] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Two techniques of duodenum-preserving resection of the head of the pancreas were compared in a prospective, randomized trial. The technical feasibility and effects on quality of life were assessed. SUMMARY BACKGROUND DATA Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Berger and Frey combine both to different degrees. The efficacy of both procedures has not been compared thus far. METHODS Forty-two patients were allocated randomly to either Beger's (n = 20) or Frey's (n = 22) group. In addition to routine pancreatic diagnostic work-up, a multidimensional psychometric quality-of-life questionnaire and and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The interval between symptoms and surgery ranged from 12 months to 12 years, with a mean of 5.7 years. The mean follow-up was 1.5 years. RESULTS There was no mortality. Overall morbidity was 14% (20% Beger, 9% Frey). Complications from adjacent organs were resolved definitively in 94% (90% Beger, 100% Frey). A decrease of 95% and 94% of the pain score after Beger's and Frey's procedure, respectively, and an increase of 67% of the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between both groups. CONCLUSIONS Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and definitive control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.
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Seitz U, Binmoeller KF, Soehendra N. Omitting side holes in biliary stents. Gastrointest Endosc 1995; 41:177-8. [PMID: 7794360 DOI: 10.1016/s0016-5107(05)80611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Binmoeller KF, Seifert H, Soehendra N. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lymph nodes. Endoscopy 1994; 26:780-3. [PMID: 7712988 DOI: 10.1055/s-2007-1009105] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The recent introduction of convex linear array echoendoscopes equipped with a biopsy channel has made fine-needle aspiration biopsy (FNAB) under direct endosonographic guidance possible. Because the imaging and instrumentation planes overlap, the operator can visualize a biopsy needle lengthwise as it enters the sector-shaped sound field. We performed EUS-guided FNAB of lymph nodes in seven patients who met the following criteria: (1) Lymph node size over > 1 cm; (2) no endoscopic or endosonographic evidence for tumor involvement of bowel wall interposed between the lymph node and the transducer; and (3) absence of coagulopathy or thrombocytopenia. A positive tissue yield was obtained in six patients, of whom five had malignant cells identified on cytology. The patient with an inadequate yield had a dry aspirate, possibly related to prior irradiation treatment for esophageal carcinoma. No procedure-related complications were observed. We conclude that EUS-guided FNAB of lymph nodes is technically feasible, provides a high diagnostic yield, and appears to be safe. Further studies to determine the sensitivity and specificity of this novel procedure are warranted.
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Koch H, Binmoeller KF, Grimm H, Soehendra N, Henning H, Oehler G. Prophylactic sclerotherapy for esophageal varices: long-term results of a prospective study. Endoscopy 1994; 26:729-33. [PMID: 7712966 DOI: 10.1055/s-2007-1009084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Controlled trials of endoscopic sclerotherapy for the prevention of the first variceal hemorrhage have given controversial results. We continued a previously reported study and randomly assigned 141 patients with esophageal varices and no prior gastrointestinal bleeding to either prophylactic sclerotherapy (n = 70) or no treatment (n = 71). Sclerotherapy was performed until complete eradication of the varices was achieved; recurrent varices were treated with repeat sclerotherapy. The groups were well balanced in terms of demographic and clinical characteristics. Patients in both groups who bled from varices received sclerotherapy whenever possible. During a median follow-up of 56 months, variceal bleeding occurred in 7% in sclerotherapy patients and 44% of control patients (p < 0.01). In the sclerotherapy group 59% died, and in the control group 51% (n.s.). In both groups, the mortality rate increased with the severity of liver function impairment. Sclerotherapy was not found to improve survival in patients, irrespective of the etiology of cirrhosis (alcoholic or nonalcoholic) or variceal size (low-grade or high-grade). We conclude that sclerotherapy is a suitable method to reduce the occurrence of the first variceal hemorrhage, but it does not appear to have an effect on survival.
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Hintze RE, Binmoeller KF, Adler A, Veltzke W, Thonke F, Soehendra N. Improved endoscopic management of severe upper gastrointestinal hemorrhage using a new wide-channel endoscope. Endoscopy 1994; 26:613-6. [PMID: 8001489 DOI: 10.1055/s-2007-1009049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Problems in emergency endoscopy for upper gastrointestinal bleeding may arise due to blood and food debris preventing proper endoscopic vision and orientation. We present here a new big channel endoscope with a 6 mm suction and drainage channel that achieved complete evacuation of stomach contents in 122 of 123 patients with upper gastrointestinal bleeding, in whom complete gastric cleaning and identification of the bleeding source had proved impossible using standard endoscopes. Gastric emptying using the big-channel endoscope was possible within five minutes in all successful cases. Optimal conditions for therapeutic procedures were therefore provided. The size of the instrumentation channel may open up new indications also for non-emergency endoscopic diagnosis and treatment.
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Soehendra N, Nam VC, Binmoeller KF, Koch H, Bohnacker S, Schreiber HW. Pulverisation of calcified and non-calcified gall bladder stones: extracorporeal shock wave lithotripsy used alone. Gut 1994; 35:417-22. [PMID: 8150358 PMCID: PMC1374602 DOI: 10.1136/gut.35.3.417] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Using a modified electromagnetic lithotripter (Siemens), extracorporeal shock wave lithotripsy (ESWL) was performed in 260 patients with gall bladder stones. Exclusion criteria for treatment were a non-functioning gall bladder, subcostal gall bladder location, and multiple stones occupying more than three quarters of the gall bladder volume. Stone pulverisation was the end point of ESWL. The number of shock wave discharges and sessions was not limited. Pulverisation was achieved in 250 patients (96.1%) after a median of three ESWL sessions (range 1-21). The number of sessions required depended upon stone composition and burden. More than three sessions were required in 60.2% of patients with calcified stones compared with 35.9% of patients with non-calcified stones (p < 0.001). 65.8% of patients with stones measuring more than 30 mm in total diameter required more than three sessions compared with 42.9% of patients with a stone burden less than 30 mm (p < 0.01). At 18-24 (8-12) months follow up, stone clearance was achieved in 94.3% (80.4%) of patients with non-calcified stones, compared with 89.5% (76.8%) in patients with calcified stones and in 75% (71.4%) of patients with a total stone diameter more than 30 mm compared with 95.7% (80.4%) for patients with a total stone diameter less than 30 mm (p < 0.05). ESWL related complications (gross haematuria) occurred in three patients. Thirty six (13.8%) patients experienced biliary colic; four had cholecystectomy, and five endoscopic papillotomy because of common bile duct obstruction. Stone recurrence was seen in 5.3% of patients over a follow up period of up to two years (median 16.6 months).
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Binmoeller KF, Soehendra N, Liguory C. The common bile duct stone: time to leave it to the laparoscopic surgeon? Endoscopy 1994; 26:315-9. [PMID: 8076552 DOI: 10.1055/s-2007-1008975] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Binmoeller KF, Seifert H, Soehendra N. Endoscopic pseudocyst drainage: a new instrument for simplified cystoenterostomy. Gastrointest Endosc 1994; 40:112. [PMID: 8163115 DOI: 10.1016/s0016-5107(94)70031-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Yekebas E, Thonke F, Binmoeller KF, Soehendra N. [Diffuse pseudo-diverticulosis of the esophagus with severe cranial stricture, axial hiatal hernia and Barrett syndrome]. LEBER, MAGEN, DARM 1993; 23:278-280. [PMID: 8309342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report about a patient with esophageal intramural pseudodiverticulosis (EIP) who was referred to our department for further investigation of dysphagia. EIP is a rare, pathologically well defined disease, most frequently characterized by stricture-associated symptoms. The diagnosis of EIP is made by barium swallow and can be confirmed by endoscopy which shows typical diverticula-like changes of the esophageal wall.
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Abstract
Electrohydraulic lithotripsy has been shown to be an effective non-surgical treatment for common bile duct and intrahepatic duct stones. This technique was applied via the endoscopic retrograde route in 14 patients (mean age, 70) with the Mirizzi syndrome, all of whom were at high risk for surgery. The procedure was performed under strict cholangioscopic guidance. Twelve patients had a single stone and two had multiple stones impacted in the cystic duct. Stone diameter was 1.5 cm in one patient, 2 to 3 cm in nine patients, and greater than 3 cm in four patients. Insertion of the babyscope and stone fragmentation were successful in all patients. Complete stone clearance required one session in 12 patients and two sessions in two patients (both with multiple stones). In one patient post-procedural leakage of contrast medium from the cystic duct into the peritoneal cavity was noted. This was attributed to pressure necrosis induced by the impacted stone. The patient had an uneventful course of recovery, and leakage resolved with conservative management. Mortality was zero. Endoscopic treatment of the Mirizzi syndrome with electrohydraulic lithotripsy seems to be an effective and relatively safe alternative to surgery.
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Binmoeller KF, Brückner M, Thonke F, Soehendra N. Treatment of difficult bile duct stones using mechanical, electrohydraulic and extracorporeal shock wave lithotripsy. Endoscopy 1993; 25:201-6. [PMID: 8519238 DOI: 10.1055/s-2007-1010293] [Citation(s) in RCA: 196] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Over a 34-month period (1989-1991), 791 patients were diagnosed at endoscopic retrograde cholangiography to have bile duct stones. All patients underwent sphincterotomy and attempted extraction by Dormia basket. This was successful in 683 patients (86%). The remaining 108 patients with "difficult stones" (mean age 72 years) underwent mechanical, electrohydraulic or extracorporeal shock wave lithotripsy according to the following algorithm: (1) Mechanical lithotripsy for stones which could not be extracted after entrapment in the Dormia basket (n = 33); (2) peroral cholangioscopic electrohydraulic lithotripsy for stones which could not be engaged in the Dormia basket (n = 65); or (3) extracorporeal shock wave lithotripsy for intrahepatic stones (n = 10). Stone fragmentation and clearance was successful in all patients treated by mechanical lithotripsy, was unsuccessful in one patient submitted to electrohydraulic lithotripsy due to inability to insert the cholangioscope into the bile duct and failed in 3 patients treated by extracorporeal shock wave lithotripsy. Overall, 95% of difficult bile duct stones refractory to conventional endoscopic basket extraction were removed using the above lithotripsy techniques. There were no serious procedure-related complications.
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Binmoeller KF, Grimm H, Soehendra N. Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma. Gastrointest Endosc 1993; 39:172-4. [PMID: 8495838 DOI: 10.1016/s0016-5107(93)70060-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Binmoeller KF, Boaventura S, Ramsperger K, Soehendra N. Endoscopic snare excision of benign adenomas of the papilla of Vater. Gastrointest Endosc 1993; 39:127-31. [PMID: 8495831 DOI: 10.1016/s0016-5107(93)70051-6] [Citation(s) in RCA: 244] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Over a 5-year period (1985 to 1990), 25 patients (11 men and 14 women, median age 68) with adenomatous tumors of the papilla of Vater judged to be benign by endoscopic appearance and forceps biopsy were included in this study. All patients had de novo tumors except for two patients who had recurrent adenomas after local surgical excision. Presenting symptoms included pain (19 patients), jaundice (9 patients), and pancreatitis (4 patients). ERCP showed bile and pancreatic duct dilation in 20 patients (6 with stones) and 2 patients, respectively. The adenoma and the papilla of Vater were excised using a standard polypectomy snare (snare papillectomy). Procedure-related complications included bleeding in two patients and acute pancreatitis in three patients. No deaths occurred. Histologic analysis showed benign adenoma with mild to moderate dysplasia in 18 patients and severe dysplasia in 1 patient. Two patients with evidence for intraductal tumor extension on ERCP were referred for surgery. Six patients had recurrences at a median follow-up of 37 months (range, 7 to 79 months), of whom one had intraductal tumor spread and underwent pancreatoduodenectomy. Five patients were re-treated endoscopically; one ultimately required surgery.
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Grimm H, Binmoeller KF, Hamper K, Koch J, Henne-Bruns D, Soehendra N. Endosonography for preoperative locoregional staging of esophageal and gastric cancer. Endoscopy 1993; 25:224-30. [PMID: 8519241 DOI: 10.1055/s-2007-1010297] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of esophageal and gastric carcinoma, we performed a prospective controlled study over a five year period. Data from 63 patients with esophageal cancer and 147 patients with gastric cancer who underwent surgery were available for comparison of the endosonographic TNM classification to the histophathological findings of the resected specimens. The overall accuracy of EUS in the assessment of tumor infiltration depth was 85.7% and 78% in esophageal and gastric cancer, respectively. The sensitivity of EUS in the detection of regional lymph node metastases was 90% in esophageal and 87% in gastric carcinoma. The most frequent causes of misdiagnoses by endosonography were microscopic tumor invasion and peritumorous inflammatory changes. The inability to traverse a tumor stenosis restricted the endosonographic evaluation in 31.6 and 14% of the cases with esophageal and gastric cancer, respectively.
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Abstract
We conducted an uncontrolled study to evaluate an improved metallic clip (Olympus hemoclip) for the endoscopic treatment of nonvariceal gastrointestinal bleeding. A total of 88 patients (mean age 63 +/- 14, 60 males) with bleeding from a wide range of sources were treated. Seventy-eight patients had active bleeding (spurting in 50, oozing in 28) and 10 patients had a nonbleeding visible vessel. Initial hemostasis was achieved in all patients with active bleeding. A total of 255 clips were placed (average of 2.9 clips per patient, range of 1-10 clips). Spurting arterial bleeders required more clips on average than oozing bleeders (3.2 versus 2.7); active bleeders required more clips than cases with nonbleeding visible vessels (3.0 versus 2.2). Mean follow-up was 397 +/- 148 days. Recurrent bleeding was observed in 5 patients, all of whom had active bleeding on initial presentation. Re-bleeding was successfully treated with hemoclips in 4 patients and one patient underwent surgery. Clips appeared to be retained well; early clip dislodgement resulted in rebleeding in only 1 patient. No complications resulted from this treatment. Clips did not impair healing of peptic ulcers. We conclude that endoscopic hemoclip placement is a highly effective and safe method for treating nonvariceal gastrointestinal bleeding and deserves comparative studies with other methods of endoscopic hemostasis.
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Binmoeller KF, Thonke F, Soehendra N. Villous adenoma of the pancreatic duct mimicking a stone: pancreatoscopic diagnosis. Gastrointest Endosc 1993; 39:79-81. [PMID: 8454154 DOI: 10.1016/s0016-5107(93)70019-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Abstract
Endoscopic management of biliary obstruction is feasible in most patients and has emerged as standard treatment. Aside from the removal of bile duct stones, placement of a biliary stent is the most commonly employed modality of management. In experienced hands, this is successful in over 90% of patients. Lower procedure-related complications and the relative non-invasive nature of endoscopic treatment has relegated surgical management to a subsidiary role. Hospitalization time rarely exceeds 1-2 days. In most patients with advanced malignant disease and short life expectancy, stenting affords effective palliation. For the majority of patients endoscopic management is preferable to the percutaneous transhepatic approach due to lower overall mortality and morbidity. Stent occlusion necessitating replacement remains a problem, but improvements in this area can be expected. New plastic stent designs are undergoing investigation. Expandable metallic stents are promising but controlled comparative trials with conventional plastic prostheses are needed. Use of expandable stents should be judicious since these cannot be removed. In the future we can look forward to advances in peroral cholangioscopic technology which may permit targeted treatment of intraductal biliary malignancies.
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Binmoeller KF, Harris AG, Dumas R, Grimaldi C, Delmont JP. Does the somatostatin analogue octreotide protect against ERCP induced pancreatitis? Gut 1992; 33:1129-33. [PMID: 1383099 PMCID: PMC1379457 DOI: 10.1136/gut.33.8.1129] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study evaluates the effect of the long acting somatostatin analogue octreotide on biochemical and clinical parameters of endoscopic retrograde cholangiopancreatography (ERCP) induced pancreatitis. Altogether 245 patients were randomised to receive either octreotide or isotonic saline. Octreotide (100 micrograms) was administered intravenously five minutes before ERCP and subcutaneously 45 minutes after ERCP. There were no significant differences in the median serum amylase and lipase activities at baseline, eight, and 24 hours after ERCP. Five patients (2%) developed clinical pancreatitis--three in the octreotide and two in the placebo groups. Excluding patients who developed pancreatitis, 43 (18%) developed abdominal pain after ERCP--21 in the octreotide and 23 in the placebo groups. There were no significant differences in the median serum amylase and lipase values between the treatment groups. None of the 52 patients who had therapeutic interventions developed pancreatitis. This study suggests that octreotide may not protect against ERCP induced pancreatitis.
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Binmoeller KF, Maeda M, Lieberman D, Katon RM, Ivancev K, Rösch J. Silicone-covered expandable metallic stents in the esophagus: an experimental study. Endoscopy 1992; 24:416-20. [PMID: 1505489 DOI: 10.1055/s-2007-1010510] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Modified silicone-covered Gianturco expandable metallic stents were placed in the normal esophagus of six young pigs. Following endoscopic examination, the stents were placed using endoscopic and fluoroscopic control. The animals were observed for eating behavior and weight gain. Stents appeared to be tolerated well based on these parameters. Three stents remained in position for the full study period, and three stents migrated into the stomach during the study. The pigs were sacrificed at four weeks and postmortem examination performed. Esophageal wall thickening and nodular inflammation were noted at the sites where the wire skirts penetrated the mucosa. Injury was limited to the region of the wire skirts and there was no injury due to the radial force of the stent body. There was no free perforation. This preliminary study suggests that endoscopic and fluoroscopic placement of modified silicone-covered Gianturco stents in the esophagus is feasible and safe. More extensive animal studies, followed by clinical investigation for palliation of malignant strictures, are warranted.
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Binmoeller KF, Dumas R, Harris AG, Delmont JP. Effect of somatostatin analog octreotide on human sphincter of Oddi. Dig Dis Sci 1992; 37:773-7. [PMID: 1563323 DOI: 10.1007/bf01296438] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effect of the long-acting somatostatin analog octreotide on the sphincter of Oddi was investigated in seven subjects referred for endoscopic sphincter of Oddi manometry. Six patients had unexplained right upper quadrant pain and one had bile duct dilatation without evidence of fixed obstruction on endoscopic retrograde cholangiopancreatography. A triple-lumen low-compliance system was used to record the sphincter of Oddi basal pressure, phasic contraction frequency, amplitude, duration, and direction of wave propagation before and after intravenous administration of octreotide in a dose of 50 micrograms. After a mean latency period of 1 min, significant changes included increased basal pressure in all seven patients, increased frequency of wave contractions in six patients, and decreased wave amplitude in six patients. The median duration of wave contraction and wave propagation sequence were not significantly influenced. Thus, octreotide has a significant stimulatory affect on the sphincter of Oddi activity, which may impair biliary and pancreatic flow.
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Abstract
Prospective controlled data of lymph node evaluation by endoscopic ultrasound in esophageal, gastric and pancreatic cancer is presented. Lymph node pattern, changes of boundaries and echogenicity were considered. Preoperative findings of endoscopic ultrasound were classified according to TNM staging. Only those cases with subsequent histologic examination of the resected specimen were entered into the study. Sensitivity of endoscopic ultrasonography (EUS) was 90% for esophageal and 87% for gastric cancer. The specificity was 72% and 88%, respectively. In spite of the overall satisfactory results of EUS in evaluation of lymph nodes, further improvement in detection and differentiation of benign and malignant nodes is required.
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