Impact of gallbladder status on the outcome in patients with retained bile duct stones treated with extracorporeal shockwave lithotripsy.

Background And Study Aims: The use of endoscopic therapy in combination with lithotripsy techniques has become increasingly common in patients with complicated common bile duct stones. In many units, although this is controversial, cholecystectomy is then performed, because of possible subsequent cholecystitis and recurrence of choledocholithiasis. The aim of this study was to investigate whether gallbladder status influences the long-term outcome in patients after extracorporeal shockwave lithotripsy (ESWL) of common bile duct stones.

Wireless capsule endoscopy in a patient with obscure occult bleeding.

A case of obscure/occult bleeding in a 39-year old man with a 7-year history of chronic fatigue and iron-deficiency anemia is presented here. Esophagogastroduodenoscopy, push enteroscopy, ileocolonoscopies, and a magnetic resonance imaging small-bowel follow-through did not reveal any abnormalities. Multiple inflammatory lesions with fibrin-covered ulcers and petechial bleeding in the area of the lower jejunum and ileum were diagnosed only with capsule endoscopy.

Pancreatic endoscopic sphincterotomy in patients with chronic pancreatitis: a single-center experience in 171 consecutive patients.

Background And Study Aims: In recent years, interest in endoscopic therapy techniques for pancreatic diseases has been constantly increasing. The aim of the present study was to assess the technical success, technique, and complications of endoscopic pancreatic sphincterotomy (EPS) in patients with chronic pancreatitis.

Patients And Methods: A total of 171 patients with chronic pancreatitis and abdominal complaints were identified in whom at least one attempt at EPS was carried out.

ERCP and MRCP--when and why.

Since the introduction of endoscopic retrograde cholangiopancreatography (ERCP) in the 1970s, gastroenterologists have a wide spectrum of diagnostic and therapeutic options in the biliopancreatic ductal system at their disposal. With its arrival in the 1990s, magnetic resonance cholangiopancreatography (MRCP) developed as a potent diagnostic tool in biliopancreatic pathology. Currently, MRCP is widely replacing diagnostic ERCP and thereby avoiding complications related to endoscopic technique.

Early bursting strength of human colon anastomoses--an in vitro study comparing current anastomotic techniques.

An experimental in vitro study involving ten hand-sutured, ten biofragmentable anastomotic ring (BAR) and ten stapled anastomoses was conducted to compare current anastomotic techniques on the basis of early bursting pressure. The 30 fresh human colon segments used in the study were harvested from patients who had undergone elective oncologic resection. Following the construction of in vitro anastomoses, the pressure required to burst these specimens was measured.

Esophageal intramural pseudodiverticulosis: review of symptoms including upper gastrointestinal bleeding.

Background: Esophageal intramural pseudodiverticulosis (EIP) is a rare condition manifested by multiple, flask-shaped outpouchings in the wall of the esophagus, which represent dilated excretory ducts of esophageal mucous glands.

Study: Five patients with EIP were evaluated with regard to symptoms and concomitant diseases, as well as endoscopic, radiologic, and manometric findings.

Results: Primary clinical symptoms reported by the five patients (three men and two women; age range, 59-72 years) were increasing dysphagia ( n = 3), upper gastrointestinal bleeding ( n = 1), and no symptoms ( n = 1).

Minilaparoscopy versus conventional laparoscopy in the diagnosis of hepatic diseases.

Background: Minilaparoscopy (ML) is being used increasingly in the diagnosis of liver disease. This is a prospective study of the accuracy and safety of ML compared with conventional laparoscopy (CL) in the diagnostic workup of liver disease.

Methods: One hundred four patients with suspected liver disease were randomized either to undergo CL (n = 50) or ML (n = 54).

Buprenorphine or procaine for pain relief in acute pancreatitis. A prospective randomized study.

Background: To assess the analgesic efficacy and side effects of buprenorphine and procaine in patients with acute pancreatitis.

Methods: Forty patients (average age, 50 years; 23 male) with acute pancreatitis or an acute bout of a chronic pancreatitis were prospectively randomized to receive buprenorphine or procaine for pain relief. Both analgesics were administered as constant intravenous (i.

Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study.

Background: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive and increasingly used procedure in cases involving biliary and pancreatic diseases. However, the accuracy of MRCP in differential diagnosis between pancreatic cancer and chronic pancreatitis has never been documented in a large prospective controlled study.

Methods: 124 patients were recruited for the study, selected from 141 consecutive patients with an average age of 55 years (range 19-80) who presented to our department between February, 1996, and January, 1998, with a strong clinical suspicion of pancreatic cancer.

Hemosuccus pancreaticus--a rare cause of gastrointestinal bleeding: diagnosis and interventional radiological therapy.

Hemorrhage from the pancreatic duct, i.e. hemosuccus pancreaticus (HP), is a rare cause of gastrointestinal bleeding.

Choledochocele imaged with magnetic resonance cholangiography.

Choledochal cysts are rare developmental malformations of the biliary tree. Percutaneous and endoscopic ultrasound, as well as endoscopic retrograde cholangiopancreatography, are recommended diagnostic tools. Magnetic resonance cholangiography may also contribute to the workup and treatment plan of patients with choledochal cysts.

Current role of magnetic resonance cholangiopancreatography in the diagnosis of common bile duct and pancreatic diseases.

Magnetic resonance cholangiopancreatography is a noninvasive procedure that is increasingly used in patients with hepatobiliary and pancreatic diseases. The accuracy of magnetic resonance cholangiopancreatography has dramatically improved during the last few years, and there is no doubt that magnetic resonance cholangiopancreatography will have a major impact on the gastroenterologist's diagnostic work-up of patients. The key for success in dealing with hepatobiliary and pancreatic diseases is the precise knowledge of their course, the indications for treatment, and the therapy available.

Adverse effects of nonsteroidal anti-inflammatory drugs on the small and large bowel.

Nonsteroidal anti-inflammatory drugs (NSAID) account for a large part of prescriptions and self-administered medication worldwide. The adverse effects on the upper gastrointestinal tract are well documented. However, in an increasing number of publications adverse effects in the small and large intestine distal to the duodenum are being reported.

Emergency carotid thromboendarterectomy: safe and effective.

Whether to perform emergency carotid thromboendarterectomy (CTEA) in the presence of crescendo transient ischemic attacks or stroke-in-evolution is controversial, with the operative mortality in some reports exceeding 20% and improvement in neurologic deficit of less than 40% in others. Our anecdotal experience with emergency CTEA for acute, persistent, or crescendo neurologic deficit had been strikingly better than published reports. Accordingly, we carried out a restrospective comparison of 43 such patients undergoing emergency CTEA with 237 patients concurrently undergoing elective CTEA for conventional indications.

Long term follow up of patients with chronic pancreatitis and pancreatic stones treated with extracorporeal shock wave lithotripsy.

Background: There have been conflicting reports as to whether pancreatic ductal drainage achieved by endoscopy and lithotripsy improves the clinical outcome of patients with chronic pancreatitis.

Aims: To determine the clinical outcome in patients with chronic pancreatitis who received extracorporeal shock wave lithotripsy (ESWL), and were followed up for two to eight years.

Methods: Eighty patients with severe chronic pancreatitis and endoscopically unretrievable obstructive stones underwent ESWL with a piezoelectric lithotripter between 1989 and 1996.

Prevalence and clinical importance of Helicobacter pylori infection in patients after partial gastric resection for peptic ulcer disease. A prospective evaluation of Helicobacter pylori infection on 50 resected patients compared with matched nonresected controls.

Unlabelled: There have been only a few surveys on the prevalence of persistent Helicobacter pylori (Hp) infection in patients who have undergone surgery for peptic ulceration. The aim of the study was to evaluate the prevalence and clinical importance of Hp infection after partial gastric surgery due to peptic ulcer disease.

Methods: We examined 50 patients who had partial gastric resection for peptic ulcer disease and years later underwent upper gastrointestinal (GI) endoscopy.

Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms.

Background: The long-term outcome after endoscopic papillotomy is poorly defined. The aim of this study was to determine the long-term results of this method in the treatment of common duct calculi and to determine which prognostic factors are associated with the relapse of biliary symptoms.

Methods: Between 1985 and 1988, 223 consecutive (149 women, mean age 67.

A prospective evaluation of magnetic resonance cholangiopancreatography in patients with suspected bile duct obstruction.

Background: The value of magnetic resonance cholangiopancreatography (MRCP) is under debate.

Aims: To assess the diagnostic accuracy of MRCP and endoscopic retrograde cholangiopancreatography (ERCP) and to determine whether MRCP may help to prevent unnecessary interventional procedures.

Methods: Eighty six patients with suspected common bile duct obstruction who presented between January and December 1996 were enrolled.

Value of magnetic-resonance cholangio-pancreatography (MRCP) after unsuccessful endoscopic-retrograde cholangio-pancreatography (ERCP).

Background And Study Aims: The present study tries to evaluate the success rate of MRCP when two attempts by experts to perform ERCP in a center failed.

Patients And Methods: From March 1996 to December 1996 thirteen patients fulfilled the inclusion criteria. The MR cholangiopancreatograms were acquired using commercially available software in a clinical MR scanner (Magnetom Expert 1 T-Scanner, Siemens, Erlangen, Germany).

Cure with omeprazole plus amoxicillin versus long-term ranitidine therapy in Helicobacter pylori-associated peptic ulcer bleeding.

Background: Long-term prophylaxis with ranitidine reduces the risk of recurrent bleeding in patients with a history of bleeding peptic ulcers. To date, no randomized study has been performed to compare cure of Helicobacter pylori infection versus H2 blocker prophylaxis in patients with bleeding peptic ulcer.

Methods: In a prospective randomized study, 95 consecutive patients with H.

Laser fragmentation of pancreatic duct stones using a rhodamine laser with an automatic stone-tissue detection system. Basic in-vitro studies.

Objectives: The aim of our study was to examine the suitability of a rhodamine 6G laser with an integrated stone-tissue detection system (STDS) for fragmenting pancreatic stones.

Methods: A total of 64 pancreatic duct stones were measured for weight, diameter, main chemical components and in some cases for their computerized tomography density. Recognition of all stones was checked with the standard STDS or a prototype version.

Fecal alpha 1-antitrypsin in newborn infants.

Background: Fecal alpha 1-antitrypsin is used as a marker for intestinal protein loss reflecting increased intestinal permeability. Exact data of fecal alpha 1-antitrypsin in newborn infants are not available.

Methods: 30 healthy mature neonates and three infants with impaired gastrointestinal passage due to stenoses and atresia respectively, were investigated during the first days of life.