AIM: To evaluate the eff icacy and safety of endoscopic balloon dilation(EBD) performed for common bile duct(CBD) stones.METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performe...AIM: To evaluate the eff icacy and safety of endoscopic balloon dilation(EBD) performed for common bile duct(CBD) stones.METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome(small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography(ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN cholangiography and, when necessary, with computed tomography of the abdomen(for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic(ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBDof the ampulla was performed under endoscopic and f luoroscopic guidance with a balloon through the scope(Hercules, wireguided balloon, Cook Ireland Ltd. and CRE, Microvasive, Boston Scientific Co., Natick, MA, United States). RESULTS: A total of 14 patients(9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy(ES) prior to the EBD. The size of balloon insuff lation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and f luoroscopic guidance. The balloon was gradually f illed with diluted contrast agent and was maintained inf lated in position for 45 to 60 s before def lation and removal. The need for precutting the major papilla was 21.4%. In one patient(an 81-year-old), EBD was performed in a Billroth Ⅱ. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures(ERCP + ES) was only an intra procedural bleeding(6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported.CONCLUSION: With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an eff icacious and safe procedure.展开更多
It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may ...It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may include the size,shape and location of the lesions.Many colorectal cancer screening programs have been proposed to increase the adenoma detection rate.The substantial difference between these methods is whether the improvement in vision,particularly the detection of irregularities of the mucosa,is inside the endoscope electronic components(magnification,wideangle vision,narrow band imaging,flexible spectral imaging colour enhancement,i-Scan) or outside the same,by the use of specific caps(EndoC uff,EndoV ision,Endo Rings).Endocuff is a plastic device mounted at the end of the scope with a constant vision field of the entire colon.The aim of this study is to explore the potential clinical and technical benefits of Endocuff.展开更多
文摘AIM: To evaluate the eff icacy and safety of endoscopic balloon dilation(EBD) performed for common bile duct(CBD) stones.METHODS: From a computer database, we retrospectively analyzed the data relating to EBD performed in patients at the gastrointestinal unit of the Sandro Pertini Hospital of Rome(small center with low case volume) who underwent endoscopic retrograde cholangiopancreatography(ERCP) for CBD from January 1, 2010 to February 29, 2012. All patients had a proven diagnosis of CBD stones studied with echography, RMN cholangiography and, when necessary, with computed tomography of the abdomen(for example, in cases with pace-makers). Prophylactic therapies, with gabexate mesilate 24 h before the procedure and with an antibiotic(ceftriaxone 2 g) 1 h before, were administered in all patients. The duodenum was intubated with a side-viewing endoscope under deep sedation with intravenous midazolam and propofol. The patients were placed in the supine position in almost all cases. EBDof the ampulla was performed under endoscopic and f luoroscopic guidance with a balloon through the scope(Hercules, wireguided balloon, Cook Ireland Ltd. and CRE, Microvasive, Boston Scientific Co., Natick, MA, United States). RESULTS: A total of 14 patients(9 female, 5 male; mean age of 73 years; range 57-82 years) were enrolled in the study, in whom a total of 15 EBDs were performed. All patients underwent minor endoscopic sphincterotomy(ES) prior to the EBD. The size of balloon insuff lation depended on stone size and CBD dilation and this was performed until it reached 16 mm in diameter. EBD was performed under endoscopic and f luoroscopic guidance. The balloon was gradually f illed with diluted contrast agent and was maintained inf lated in position for 45 to 60 s before def lation and removal. The need for precutting the major papilla was 21.4%. In one patient(an 81-year-old), EBD was performed in a Billroth Ⅱ. Periampullary diverticula were found only in a 74-year-old female. The adverse event related to the procedures(ERCP + ES) was only an intra procedural bleeding(6.6%) that occurred after ES and was treated immediately with adrenaline sclerotherapy. No postoperative complications were reported.CONCLUSION: With the current endoscopic techniques, very few patients with choledocholithiasis require surgery. EBD is an eff icacious and safe procedure.
文摘It is well-known that colonoscopy is considered the gold standard for colon cancer prevention.Although performed by experienced endoscopists,the matter remains of polyps missed during this examination.The reasons may include the size,shape and location of the lesions.Many colorectal cancer screening programs have been proposed to increase the adenoma detection rate.The substantial difference between these methods is whether the improvement in vision,particularly the detection of irregularities of the mucosa,is inside the endoscope electronic components(magnification,wideangle vision,narrow band imaging,flexible spectral imaging colour enhancement,i-Scan) or outside the same,by the use of specific caps(EndoC uff,EndoV ision,Endo Rings).Endocuff is a plastic device mounted at the end of the scope with a constant vision field of the entire colon.The aim of this study is to explore the potential clinical and technical benefits of Endocuff.
