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Mahadev S, Aroniadis OS, Barraza L, Agarunov E, Goodman AJ, Benias PC, Buscaglia JM, Gross SA, Kasmin FE, Cohen JJ, Carr-Locke DL, Greenwald DA, Mendelsohn RB, Sethi A, Gonda TA. Impact of the COVID-19 pandemic on endoscopy practice: results of a cross-sectional survey from the New York metropolitan area. Gastrointest Endosc 2020; 92:788-789. [PMID: 32339595 PMCID: PMC7182511 DOI: 10.1016/j.gie.2020.04.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Luis Barraza
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Emil Agarunov
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Amrita Sethi
- NYP-Columbia University Irving Medical Center, New York, New York, USA
| | - Tamas A Gonda
- NYP-Columbia University Irving Medical Center, New York, New York, USA
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Voaklander R, Kim E, Brown WH, Kasmin FE, Siegel JH. An Overview of the Evolution of Direct Cholangioscopy Techniques for Diagnosis and Therapy. Gastroenterol Hepatol (N Y) 2016; 12:433-437. [PMID: 27489525 PMCID: PMC4969779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Direct examination of the biliary tree with endoscopes has been a challenge since endoscopists began performing endoscopic retrograde cholangiopancreatography (ERCP) in the late 1960s. Previously, surgeons had used rigid instruments intraoperatively, which made examination difficult. The first direct cholangioscopy performed by an endoscopist was likely unintentionally done in a patient with postsurgical anatomy. Indirect imaging, ERCP, and percutaneous transhepatic cholangiography are helpful modalities for examining the biliary tree, but they are limited procedures, particularly with regard to the evaluation and treatment of strictures and bile duct stones. This article reviews the history and evolution of direct cholangioscopy since the advent of flexible endoscopes. Additionally, the article describes a new single-operator cholan-gioscopy technique for direct visualization of the biliary tree for diagnosis and intervention. There remains opportunity for innovation as endoscopists strive for safe and less-invasive methods for the identification and treatment of biliary pathology.
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Affiliation(s)
- Rebecca Voaklander
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Eileen Kim
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - William H Brown
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Franklin E Kasmin
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Jerome H Siegel
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Voaklander and Dr Kim are residents in the Department of Internal Medicine. Dr Brown, Dr Kasmin, and Dr Siegel are attending physicians in the Department of Internal Medicine and founders of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
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Kim E, Voaklander R, Kasmin FE, Brown WH, Mannan R, Siegel JH. Autoimmune Pancreatitis: A Multiorgan Disease Presenting a Conundrum for Clinicians in the West. Gastroenterol Hepatol (N Y) 2015; 11:606-11. [PMID: 27482182 PMCID: PMC4965620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Autoimmune pancreatitis (AIP), a clinical entity originally described in East Asia and more recently recognized in the United States and Europe, poses a diagnostic conundrum for clinicians in the West due to immunoglobulin G4 seronegativity. Although expert panels classify this disease into 2 types, it remains difficult to stratify the disease given that both types share most clinical, biochemical, and imaging characteristics. The classic presentation of AIP can mimic that of pancreatic carcinoma, which increases the urgency of evaluation, diagnosis, and treatment. In this article, we elucidate the differences between the 2 types of AIP, highlight the shortcomings of the current classification system, and propose a more inclusive view of the disorder.
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Affiliation(s)
- Eileen Kim
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Rebecca Voaklander
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Franklin E Kasmin
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - William H Brown
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Rifat Mannan
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Jerome H Siegel
- All of the authors are affiliated with Mount Sinai Beth Israel in New York, New York. Dr Kim and Dr Voaklander are residents in the Department of Internal Medicine. Dr Mannan is a resident in the Department of Pathology. Dr Kasmin, Dr Brown, and Dr Siegel are attending physicians in the Department of Internal Medicine and codirectors of the Advanced Fellowship in Therapeutic Endoscopy. Dr Siegel is also a clinical professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, New York
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Abstract
The diagnosis and treatment of patients with pancreatic strictures presents a multitude of clinical challenges. The etiology of pancreatic strictures is varied, including benign strictures subsequent to acute pancreatitis, trauma, postsurgical, post-endoscopic retrograde cholangiopancreatography (ERCP), and malignancy. Patients with strictures usually present with symptoms of recurrent pancreatitis, abdominal pain, weight loss, and/or steatorrhea. The absence of a prior history of pancreatitis or surgery increases the likelihood of malignancy. High-quality imaging studies of the pancreas, CT, MRI/magnetic resonance cholangiopancreatography, or endoscopic ultrasound (EUS) scanning are utilized for better definition. Imaging detects an associated mass and/or demonstrates the ductal anatomy. Invasive procedures such as ERCP are performed to better define the causal relationships of the patient's symptoms or to obtain tissue diagnosis. Treatment goals include ameliorating symptoms, dilating the stricture, and ruling out cancer. The risk of malignancy underlies much of the intervention, which includes serology, cytologic analysis, and serial imaging. EUS has become the procedure of choice to rule out a mass, to evaluate the parenchyma for evidence of chronic pancreatitis, and to obtain fine-needle biopsies for tissue confirmation. In symptomatic patients or patients with indeterminate strictures, ERCP is used for direct pancreatography, tissue acquisition, and endoscopic treatment. Endotherapy includes sphincterotomy, dilation, and stenting to provide drainage. We view ERCP as the optimal first-line treatment modality. ERCP offers the potential of curative treatment and is less invasive than surgery, especially as some patients' symptoms are not severe enough to justify surgery. If patients do not experience relief of symptoms after several sessions of endoscopic therapy, surgery is the logical next step for definitive, long-term treatment.
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Ollar RA, Cooperman AM, Wayne ME, Barrecchia JF, Sonpal N, Duddempudi S, Kasmin FE. A colorimetric method for detection of K-ras codon 12 point mutations in DNA extracted from tissue and peripheral blood in pancreatic disorders. Biochem Genet 2010; 48:577-89. [PMID: 20383741 DOI: 10.1007/s10528-010-9340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 01/11/2010] [Indexed: 01/06/2023]
Abstract
Molecular-based methods to monitor point mutations require special and expensive equipment unavailable in most hospitals. Colorimetric-based analysis is an ideal platform for K-ras codon 12 gene point mutations because it uses commonly found hospital equipment. The colorimetric assay is sensitive and specific, detecting mutated DNA levels as low as 1% in a wild-type background. Paired genomic DNA extracts of fixed tissue and cellular fractions of peripheral blood are more sensitive and accurate than unpaired samplings. This approach has the potential to improve K-ras point mutation scans as well as to detect micrometastases in circulating tumor cells.
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Affiliation(s)
- Robert A Ollar
- Department of Surgery, St. Vincent's Hospital Manhattan, New York, NY 10011, USA.
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Rajendra A, Cohen SA, Kasmin FE, Siegel JH, Leitman M. Surgical clip migration and stone formation in a gallbladder remnant after laparoscopic cholecystectomy. Gastrointest Endosc 2009; 70:780-1. [PMID: 19640523 DOI: 10.1016/j.gie.2009.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 05/12/2009] [Indexed: 02/08/2023]
Affiliation(s)
- Arathi Rajendra
- Division of Digestive Diseases, Beth Israel Medical Center, New York, New York, USA
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Singh P, Gurudu SR, Davidoff S, Sivak MV, Indaram A, Kasmin FE, Nozdak V, Wong RCK, Isenberg G, Stark B, Bank S, Chak A. Sphincter of Oddi manometry does not predispose to post-ERCP acute pancreatitis. Gastrointest Endosc 2004; 59:499-505. [PMID: 15044885 DOI: 10.1016/s0016-5107(03)02876-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sphincter of Oddi manometry is helpful in selecting patients with sphincter of Oddi dysfunction who will respond to sphincterotomy. However, studies have shown that sphincter of Oddi manometry is associated with a high risk of post-procedure pancreatitis. The primary objective of this study was to evaluate the safety of sphincter of Oddi manometry in patients with sphincter of 2Oddi dysfunction. The secondary objective was to determine the risk factors for post-ERCP pancreatitis in patients with sphincter of Oddi dysfunction. METHODS Data were collected retrospectively for 268 patients who had elective ERCP performed at 3 tertiary care medical centers between 1996 and 2000. Consecutive patients with suspected sphincter of Oddi dysfunction formed the case group; the control group consisted of patients with bile duct stone. The case group was further subclassified into group A, patients who underwent sphincter of Oddi manometry followed by immediate ERCP, and group B, patients who had ERCP without manometry. The rate of post-ERCP acute pancreatitis was compared between case and control groups. RESULTS Twenty-seven percent of patients in the case group with suspected sphincter of Oddi dysfunction developed acute pancreatitis compared with 3.2% of patients in the control group with bile duct stone (p<0.001). There was no significant difference in the rate of acute pancreatitis in patients with sphincter of Oddi dysfunction who underwent sphincter of Oddi manometry and ERCP compared with patients with sphincter of Oddi dysfunction who had ERCP without sphincter of Oddi manometry (odds ratio 0.72: 95% CI[0.08, 9.2]). Multivariable logistic regression analysis showed that biliary sphincterotomy (p=0.006) and pancreatography (p=0.03) were independent predictors of acute pancreatitis. CONCLUSIONS Patients with suspected sphincter of Oddi dysfunction are at higher risk of post-ERCP acute pancreatitis. Sphincter of Oddi manometry by itself does not appear to predispose to this complication.
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Affiliation(s)
- Pankaj Singh
- Current affiliations: Division of Gastroenterology, University Hospitals of Cleveland, Cleveland, Ohio, USA
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Abstract
Endoscopic therapy for chronic pancreatitis is feasible and effective in selected patients. The management of pain and ductal obstruction is most effective if reversal of the obstructive process--stricture or stone--is successful and durable. Multiple endoscopic modalities are available, and new technologies will continue to advance the capabilities of therapeutic pancreatic endoscopists. Adjunctive treatments, such as ESWL, enhance the success of these techniques. These varied therapies, although attractive and theoretically sensible, have not been compared in a randomized, controlled fashion with standard surgical therapies. In this sense, they remain experimental. Nonetheless, these techniques are widely applied in advanced endoscopy centers worldwide, and uncontrolled individual series are expected to continue to expound on and demonstrate the effectiveness of these minimally invasive interventions until randomized, prospective studies become available.
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Affiliation(s)
- F E Kasmin
- Albert Einstein College of Medicine, and Department of Medicine, Beth Israel Medical Center, New York, New York, USA
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Siegel JH, Cohen SA, Kasmin FE. Experience and volume: the ingredients for successful therapeutic endoscopic outcomes, especially ERCP and postgastrectomy patients. Am J Gastroenterol 2000; 95:2133-4. [PMID: 10950082 DOI: 10.1111/j.1572-0241.2000.02212.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Siegel JH, Cohen SA, Kasmin FE. Re: Uchida et al. Endoscopic lithotomy of common bile duct stones with sublingual nitroglycerin and guidewire. Am J Gastroenterol 1998; 93:845-6; author reply 847. [PMID: 9625148 DOI: 10.1111/j.1572-0241.1998.845a_a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Leo MA, Aleynik SI, Siegel JH, Kasmin FE, Aleynik MK, Lieber CS. F2-isoprostane and 4-hydroxynonenal excretion in human bile of patients with biliary tract and pancreatic disorders. Am J Gastroenterol 1997; 92:2069-72. [PMID: 9362195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess parameters of lipid peroxidation in bile of patients with hepatobiliary and pancreatic diseases. METHODS F2-isoprostanes (F2-IPs) and 4-hydroxynonenal (4-HNE) were measured in bile collected during 31 ERCP procedures using gas chromatography/mass spectrometry. RESULTS In 11 subjects with normal ERCP (controls), bile contained significant amounts of F2-IPs (188 +/- 27 pg/ml) and 4-HNE (37.5 +/- 8.0 ng/ml). In 10 individuals with bile duct stones, there was a 3-fold increase of F2-IPs (523 +/- 129 pg/ml; p < 0.05) and a 2.5-fold increase of 4-HNE (89.6 +/- 18.0 ng/ml; p < 0.05). In 10 patients with various pancreatic diseases, bile F2-IPs were also enhanced (545 +/- 112 pg/ml; p < 0.01). There was no significant change in alpha-tocopherol, whereas beta-carotene was decreased in biliary tract and pancreatic diseases (p < 0.05). Results of serum liver tests were normal with the exception of bilirubin, which was increased together with alkaline phosphatase. Concentrations of total lipids, phospholipids, and cholesterol did not differ significantly between the three groups. CONCLUSIONS These data provide the first evidence in humans supporting the role of oxidative stress in the pathogenesis of biliary and pancreatic disease.
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Affiliation(s)
- M A Leo
- Section of Liver Disease & Nutrition, Alcohol Research Center, Bronx VA Medical Center 10468, USA
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Abstract
Elderly people commonly present with biliary tract disease. Gallstone disease is an important cause of recurrent abdominal symptoms, and we advocate an aggressive approach in stable patients not at risk to improve the quality of their lives. Choledocholithiasis is optimally treated by ERCP (98% success) even in patients who are at great risk. Endoscopic intervention often obviates the need for emergency biliary tract surgery in the elderly, is better tolerated, and is associated with significantly less risk and a lower mortality. In contrast, emergency surgery in the elderly is poorly tolerated. Even cholecystitis and biliary pancreatitis (not discussed here) are amenable to endoscopic treatment. Malignant biliary obstruction should not and cannot be treated as aggressively as benign disorders affecting the biliary tree as the long term outlook is poor. Endoscopic palliation usually suffices in maximising treatment and improving the patient's quality of life with few associated complications or postprocedural machinations (drainage bags or tubes). The afflicted population in general and the elderly in particular benefit from minimally invasive endoscopic decompression techniques.
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Affiliation(s)
- J H Siegel
- Endoscopy Section, Beth Israel Medical Center North Division, New York, New York 10128, USA
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Abstract
Complications associated with ERCP have been well defined, clinically recognized, and effectively managed conservatively. Few patients require surgery or prolonged hospitalization. The morbidity and mortality associated with ERCP and sphincterotomy have remained low, and, although the outcome of endoscopy is equivalent or better than surgical or radiologic techniques, the complications are less. Despite the general acceptance of ERCP, its therapeutic applications, its more universal performance, and the morbidity and mortality rates have remained the same or lower since its introduction a quarter of a century ago.
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Affiliation(s)
- S A Cohen
- Beth Israel Medical Center North Division, 170 East End Avenue at 87th Street, New York, NY 10128, USA
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Abstract
BACKGROUND The use of needle-knife sphincterotomy as a method of precut sphincterotomy has been criticized as potentially unsafe. Despite this, a number of tertiary referral centers have reported their successful use of this technique to increase the rate of common bile duct cannulation. METHODS We assessed the safety and efficacy of needle-knife sphincterotomy in 72 consecutive patients in whom attempts at standard common bile duct cannulation were unsuccessful. Bile duct diameters were correlated to the complication rate. RESULTS Cannulation of the common bile duct was successful immediately after needle-knife sphincterotomy in 50 patients (67%), and was successful in 17 of the 20 patients who underwent repeat ERCP, for a total cannulation rate of 93%. Eight patients (11%) experienced complications. Retroduodenal perforation during guide wire cannulation attempts and bleeding occurred as frequently as pancreatitis. Small duct size was a risk factor for complications. There was no procedure-related mortality, and all complications were managed medically. CONCLUSIONS Needle-knife sphincterotomy was effective in facilitating cannulation in patients in whom standard cannulation attempts failed. Limiting guide wire manipulation of the fresh sphincterotomy site and excluding patients with small duct size may further reduce the complication rate.
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Affiliation(s)
- F E Kasmin
- Beth Israel Medical Center, New York, New York, USA
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Kasmin FE. Gastric syphilis. Am J Gastroenterol 1995; 90:1541-2. [PMID: 7661195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Laparoscopic cholecystectomy is the technique of choice for cholecystectomy. No experience with congenital abnormalities of the gallbladder has been reported. We report here the case of a 42-year-old woman who developed recurrent symptoms seven months after laparoscopic cholecystectomy and was found to have the majority of her gallbladder still intact. We speculate that the patient had a bilobate gallbladder as the explanation for the mishap. She subsequently underwent open repeat surgery.
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Affiliation(s)
- S A Cohen
- Section of Endoscopy, Beth Israel Medical Center North Division, New York, USA
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Siegel JH, Cohen SA, Kasmin FE. Scruples not rubles: is therapeutic ERCP being utilized appropriately? Am J Gastroenterol 1995; 90:169-70. [PMID: 7801937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Performing sphincterotomy when either Billroth II gastrectomy or complicated periampullary diverticula are present may increase the risk of complications. In addition a sphincterotomy on the main pancreatic sphincter or the papilla of Santorini presents complicated problems. Stent-guided sphincterotomy has been utilized in 229 patients presenting to our institution from 1983 through 1992. They were performed in 67 patients who had undergone Billroth II gastrectomy, 23 with periampullary diverticula, 57 with pancreas divisum, and 82 with a history of recurrent pancreatitis. To prevent ductal injury or perforation, a stent is first inserted into the biliary or pancreatic duct to guide the sphincterotomy incision. The sphincterotomy is performed using electrocautery current delivered through a "needle knife" sphincterotome. Pancreatitis occurred in 19 patients (8.3%). It was mild in 17 and moderate in two patients. One patient experienced severe hemorrhage requiring surgery. No mortality or perforations occurred. The stent-guided needle knife sphincterotomy approach is an effective technique. It has a low complication rate even in these difficult anatomic conditions. It assures that the incision precisely follows the duct when performing pancreatic sphincterotomy.
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Affiliation(s)
- J H Siegel
- Section of Endoscopy, Beth Israel Medical Center North Division, New York, New York
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Abstract
Recurrent biliary pancreatitis frequently is associated with an intact gallbladder containing stones. This condition has been effectively treated by removing the gallbladder, but there is evidence that endoscopic sphincterotomy might obviate the need for cholecystectomy in some patients. We performed prophylactic sphincterotomy in 49 patients who presented with biliary pancreatitis more than once and who were considered at risk for surgery. The majority (39 patients) were treated electively after resolution of pancreatitis, while the remainder (10 patients) were treated urgently during their index admission because of continuing symptoms. No patient experienced recurrent pancreatitis over a mean follow-up period of 48 months. No mortality occurred in this endoscopic series, and no significant morbidity was experienced. Based on our results, we advocate performing sphincterotomy in the aged patient or younger patients considered at high risk for surgery who present with a history of recurrent pancreatitis and cholelithiasis.
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Affiliation(s)
- J H Siegel
- Section of Endoscopy, Beth Israel Medical Center North Division, New York, New York
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Cohen SA, Surapaneni RK, Kasmin FE, Siegel JH. Communication between the main pancreatic duct and cystic cavity in patients with cystic neoplasms of the pancreas. Radiology 1994; 192:582-3. [PMID: 8029440 DOI: 10.1148/radiology.192.2.582-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Siegel JH, Rodriquez R, Cohen SA, Kasmin FE, Cooperman AM. Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series. Am J Gastroenterol 1994; 89:1142-6. [PMID: 8053424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the outcome of endoscopic techniques as the solitary treatment modality for the complete management of ascending, bacterial cholangitis, compared with results of radiological and surgical methods as historical controls. METHODS Endoscopic techniques were used to decompress bile ducts obstructed by stones (898 patients) or stenosis (49 patients). Endoscopic sphincterotomy (ES) was performed in 839 patients, and either 7-Fr straight stents (79), or nasobiliary tubes (29), were utilized as initial therapy in 108 patients. Of these latter patients, 68 subsequently underwent ES and stone removal, 17 had ES, lithotripsy, and stone removal, 18 were left with stents in place, and 5 were lost to follow-up. Follow-up was conducted by direct patient contact, by telephone, or through the referring physicians. RESULTS All patients were managed by endoscopic techniques. There were four deaths (0.42%) in the first 30 days (none before 2 wk); no deaths were related to the procedures but were attributed to intercurrent medical problems. Two patients underwent surgery: one pancreatitis, one perforation. Complications were infrequent, occurring in 6% of patients. Bleeding occurred in 3%, pancreatitis in 2.8%, and perforation 0.2%. CONCLUSIONS Endoscopic management of cholangitis is as effective as surgical or radiological methods for managing bacterial cholangitis, a potentially fatal syndrome, but ERCP and ES have been shown to be safer. Endoscopy is the preferred index technique both for establishing a definitive diagnosis and providing therapy.
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Affiliation(s)
- J H Siegel
- Department of Medicine, Beth Israel Medical Center, New York, NY
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Kasmin FE, Cohen SA, Siegel JH. Passage of the colonoscope "over the forceps" to achieve total colonoscopy in difficult cases. Endoscopy 1994; 26:330-1. [PMID: 8076559 DOI: 10.1055/s-2007-1008982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- F E Kasmin
- Division of Endoscopy, Beth Israel Medical Center, New York, NY
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Cohen SA, Kasmin FE, Siegel JH, Cohen D. ERCP after laparoscopic cholecystectomy. Gastrointest Endosc 1994; 40:255-6. [PMID: 8013840 DOI: 10.1016/s0016-5107(94)70186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kasmin FE, Cohen SA, Siegel JH. Latex seal for leaky endoscope valve. Gastrointest Endosc 1993; 39:858-9. [PMID: 8293928 DOI: 10.1016/s0016-5107(93)70294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cohen SA, Kasmin FE, Siegel JH. Another unusual guidewire complication in the common bile duct. Am J Gastroenterol 1993; 88:969-71. [PMID: 8503404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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