A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction.

Objective: Palliation of malignant esophageal obstruction is an important clinical problem. Expandable metal stents are a major advance in therapy, but many stents become obstructed because of tumor ingrowth. The aim of this study was to compare a new, membrane-covered expandable metal stent to conventional prostheses in a randomized controlled trial.

Modified splitting technique for liver transplantation in adult-sized recipients. Technique and preliminary results.

In the common split liver technique the liver is divided between the right lobe, to be transplanted to an adult, and the left lateral segment, to be transplanted to a small child. We have developed an alternative technique by which the cadaver donor liver is divided in its two anatomo-functional halves, both apt to be transplanted to adults or children of adult size. We have so far used this technique in three multi organ donors, generating, six liver grafts that we transplanted to six recipients with median age of 36.

Circulating Epstein-Barr virus DNA to monitor lymphoproliferative disease following pediatric liver transplantation.

Epstein-Barr virus (EBV) infection can induce uncontrolled lymphocyte B proliferation in immunosuppressed transplant patients. Monitoring circulating EBV-infected lymphocytes can help in identifying patients at risk of posttransplant lymphoproliferative disease (PTLD). Circulating EBV genome levels were determined in 54 liver transplant pediatric recipients.

Rejection and tacrolimus conversion therapy in paediatric liver transplantation.

Rejection and efficacy of rescue therapy with tacrolimus were evaluated in 50 children who underwent primary, ABO-compatible, liver transplantation. Six patients who died within the first week and one child who underwent retransplantation from an ABO-incompatible donor were excluded from the study. No patient or graft were lost due to rejection.

Liberal policy of split liver for pediatric liver transplantation. A single centre experience.

We adopted a liberal policy of extensive use of split liver in a pediatric liver transplantation (LT) program. Over a 19-month period, we have performed 64 LT in 54 patients with pediatric indications. One patient received two liver grafts as a part of a liver-small bowel transplantation and was not considered.

Extensive use of split liver for pediatric liver transplantation: a single-center experience.

The results of the extensive use of in situ liver splitting in a pediatric liver transplant program are presented. All referred donors were considered for split liver, and when the donor-recipient body weight ratio (DRWR) was greater than 2, the grafts were split. A modified split-liver technique was adopted when the DRWR was 2 or less.

Endoscopic laser ablation of nondysplastic Barrett's epithelium: is it worthwhile?

The clinical value of endoscopic ablation of nondysplastic Barrett's epithelium is controversial. It has been stated that ablation, combined with acid suppression or antireflux surgery, may reduce the risk of adenocarcinoma, thereby obviating the need for endoscopic surveillance in these patients. Eighteen symptomatic patients were enrolled in a prospective study of Nd:YAG laser ablation of Barrett's esophagus followed by treatment with proton pump inhibitors or antireflux surgery.

Endoscopic palliation of oesophageal cancer: results of a prospective comparison of Nd:YAG laser and ethanol injection.

Objective: To evaluate the effectiveness of intratumoral alcohol injection compared with Nd:YAG laser in the treatment of unresectable fungating cancers of the oesophagus.

Design: Prospective, randomised clinical study.

Setting: University hospital, Italy.

Duodeno-gastro-esophageal reflux after gastric surgery: surgical therapy and outcome in 42 consecutive patients.

Background/aims: Duodeno-gastro-esophageal reflux is a common event after gastric surgery and can result in severe symptoms and mucosal injury. Medical therapy is largely ineffective. The most common remedial operation consists of a long isoperistaltic Roux-en-Y limb in order to shunt duodenal contents away from the gastric pouch and the esophagus.

Disconnection of the ampulla of Vater: a new technique for reconstruction.

We report the case of a 42 year-old patient who had undergone gastric resection and Billroth I reconstruction for a duodenal ulcer 15 years earlier. The patient was admitted to our Department for a high output biliopancreatic fistula which developed after another gastric resection with Billroth II reconstruction which was performed for a peptic stricture of the gastroduodenal anastomosis. At laparotomy, a complete disconnection of the ampulla of Vater was found, with the duodenal stump oversewn 5 cm distally to the papillary area.

Surgical therapy in patients with failed antireflux repairs.

Background/aims: Failure of antireflux surgery may be due to errors in patient selection, errors in the choice of the operation, or technical errors in the performance of the operation. The purpose of this work was to review a series of patients surgically treated for a failed antireflux procedure over the past two decades.

Materials And Methods: Seventy patients (62%) out of 113 consecutive individuals presenting with symptoms after one or more operations for gastroesophageal reflux disease underwent reoperation.

Minimally invasive surgery for Zenker diverticulum: analysis of results in 95 consecutive patients.

Objective: To assess the effectiveness of transoral stapled diverticulum esophagostomy in relieving symptoms and decreasing outflow resistance at the pharyngoesophageal junction in patients with Zenker diverticulum.

Design: Cohort study. From April 1, 1992, until May 31, 1996, the operation was attempted in 95 patients.

Surgical treatment of the redundant interposed colon after retrosternal esophagoplasty.

Redundancy of the interposed colon used as an esophageal substitute is a common finding in the long-term follow-up of these patients. When symptoms caused by food retention in the colonic loop occur, surgical correction is necessary to improve quality of life and to prevent aspiration. We report a technique to straighten the redundant colon that consists of a side-to-side colocolic anastomosis using a linear stapler.

Improving results of esophageal stenting: a study on 160 consecutive unselected patients.

Background And Study Aims: Esophageal stenting is a valuable treatment in the management of malignant dysphagia. Recently, self-expanding stents have proved effective in reducing morbidity and mortality. The aim of this study was to evaluate the early and late results of esophageal stenting in a series of 160 consecutive unselected patients with unresectable esophageal and cardial carcinoma treated between November 1992 and December 1996.

Preoperative laparoscopy in management of patients with carcinoma of the esophagus and of the esophagogastric junction.

Background And Objectives: Adequate preoperative staging of patients with esophageal and cardia carcinoma offers the potential for a rational choice of the therapy. The aim of this study was to assess the diagnostic value of laparoscopy compared to ultrasonography (US) and computed tomography (CT) in detecting intra-abdominal metastatic spread.

Methods: Between November 1995 and December 1996, 36 patients with adenocarcinoma of the cardia and 14 patients with squamous cell carcinoma of the lower third of the esophagus were studied with CT scan and US, followed by laparoscopy performed at the same session of planned surgical resection.

Evaluation of leiomyoma of the esophagus with endoscopic ultrasonography.

Fourteen patients with suspected leiomyoma of the esophagus were studied by endoscopic ultrasonography, computed tomography, endoscopy and barium swallow. The results were correlated with the histology of the resected specimens: in 2 patients with a peduncolated leiomyoma originating from the second echographic layer, endoscopic resection was performed. Endoscopic ultrasonography was superior to other imaging techniques in detection and staging of leiomyoma because it can determine the layer of origin, the direction of the growth and the consistency of the tumor.