Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and extreme weight loss as a result of severe malabsorption syndrome. The abdominal roentgenogram showed a typical hypotonic intestine with an enlarged stomach and distended intestinal loops with the radiological signs of an ileus.

Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.

We present a prospective, unrandomized, uncontrolled series of 1272 patients in whom endoscopic sphincterotomy (ES) was performed, and who had not previously undergone cholecystectomy. These patients were culled from our combined experience of a total of 4177 patients in whom ES was performed over the last 13 yr. Of the group reported here, 1208 patients had demonstrable gallbladder stones, and 64 had acalculous gallbladders.

[Endoscopic diagnosis and therapy of papillary tumors].

Endoscopic papillotomy (EPT) allows biopsy of tumors of the Vater's papilla using coils or forceps. EPT is a preoperative diagnostic procedure in patients with carcinoma of the papilla, who can be operated upon, a palliative procedure in patients which cannot be operated upon anymore, and a curative procedure in patients with benign tumors which cannot be operated upon because of general risk factors. EPT is also a preparatory procedure for internal drainage of the bile duct system by endoscopy.

[Treatment of duodenal ulcer with synthetic depot secretin - a double-blind study].

63 inpatients with duodenal ulcer disease were treated with either depot-secretin or placebo. Two different secretin-regimens were used. In group I 18 patients were given secretin twice daily.

[Endoscopic bile duct drainage in malignant obstructive jaundice--an alternative procedure to palliative surgery].

74 patients suffering from malignant bile duct obstruction were treated by endoscopic endoprosthesis placement. Improvement and standardization of the technique resulted in successful decompression in 97% of the cases. Also, the complication rate could be reduced to 6.

[Endoscopic transpapillary bile duct drainage in malignant obstructive jaundice].

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.

[Spontaneous migration of large stones from the bile duct (author's transl)].

Spontaneous migration of bile-duct stones through the papilla into the intestine was directly observed in two patients with choledocholithiasis. The mechanism of such spontaneous migration lies in the development of a pressure necrosis at the papilla causing a tear in its pore. Spontaneous migration of stone from the common bile duct can be assumed when endoscopic retrograde cholangiopancreatography reveals a balloon-shaped swollen papilla with a torn pore, and previously observed obstructive jaundice regresses in the presence of stone-free, though perhaps somewhat dilated, bile passages.

Complications of endoscopic sphinecterotomy and their treatment.

Despite the careful observance of standard precautions during endoscopic sphincterotomy, serious complications are sometimes unavoidable and these may require various forms of treatment. Surgical intervention is necessary for fulminating pancreatitis, acute arterial hemorrhage, and retroperitoneal abscess. The endoscopic insertion of a drainage tube into the common bile duct can serve to overcome biliary obstruction due to cholangitis secondary to stone impaction, Dormia basket impaction or blood clot.

A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis.

Eleven patients wtih gallstone-related acute pancreatitis underwent urgent duodenoscopy and diathermy sphincterotomy; six had stones impacted at the papilla of Vater, and the remainder had stones in the bile duct. One patient had a gallstone in the pancreatic duct. Endoscopic removal of the duct stones resulted in a prompt, persistent clinical and biochemical improvement, except in one patient who had been referred from another hospital with a pseudocyst 3 weeks after the onset of illness.

[Endoscopic papillotomy for acute pancreatitis caused by biliary disease (author's transl)].

In 15 patients with acute pancreatitis caused by biliary disease endoscopic sphincterotomy was performed after diagnostic ERCP. All patients had a history of symptoms pointing to long-standing biliary disease, such as typical right-sided upper abdominal pain, signs of biliary stasis, and jaundice. An impacted solitary ampullar stone was demonstrated in eight patients while in seven several stones were found in the biliary tract.

Endoscopic sphincterotomy in patients with Billroth II gastrectomy.

We attempted endoscopic sphincterotomy in 35 patients previously subjected to Billroth II gastrectomy, and succeeded in 23 of them. It is often difficult to pass the instrument along the afferent loop and the sphincterotomy incision is seldom placed in an optimal position. Although we had complications in only 2 patpients, it is likely that spincterotomy carries a higher risk in Billroth II gastrectomy patients.

Intraduodenal manipulations of the common bile duct.

The history of the development and technique of endoscopic sphincterotomy are discussed. This includes a review of 796 successful sphincterotomies out of 838 attempts. The indications for sphincterotomy were choledocholithiasis in 632 patients, stenosis of the papilla of Vater in 136, periampullary tumor in 24, and stones in the main pancreatic duct in 4 patients.

Endoscopic treatment of biliary-tract diseases. An international study.

Data on endoscopic sphincterotomy from 15 gastroenterology centres with very wide experience show that 3618 out of 3853 (93.%) attempts at the procedure were successful. The main indication for sphincterotomy was choledocholithiasis (3070, or 84.