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Pancreatic sphincterotomy:Technique,indications,and complications

World Journal of Gastroenterology 2007年第30期13卷 4064-4071页

作者： Jonathan M Buscaglia anthony n kalloo Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine Johns Hopkins Hospital Baltimore MD 21205 United States

Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically, its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy: a pull-type sphincterotome technique without prior stent placement, and a needle-knife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde cholangio-pancreatography.

关键词： Pancreas Sphincterotomy Endoscopic Technique Indications Complications

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Retrograde-viewing device improves adenoma detection rate in colonoscopies for surveillance and diagnostic workup

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World Journal of Gastroenterology 2012年第26期18卷 3400-3408页

作者： Peter D Siersema Amit Rastogi Anke M Leufkens Paul A Akerman Kassem Azzouzi Richard I Rothstein Frank P Vleggaar Alessandro Repici Giacomo Rando Patrick I Okolo Olivier Dewit Ana Ignjatovic Elizabeth Odstrcil James East Pierre H Deprez Brian P Saunders anthony n kalloo Bradley Creel Vikas Singh Anne Marie Lennon Daniel C DeMarco Department of Gastroenterology and Hepatology University Medical Center Utrecht3508 GA UtrechtThe Netherlands Division of Gastroenterology and Hepatology Kansas City Veterans Administration Medical CenterKansas CityMO 64128United States Department of Gastroenterology Bayside Endoscopy Center33 Staniford StreetProvidenceRI 02905United States Department of Gastroenterology Cliniques Universitaires Saint-LucUniversité Catholique de LouvainB-1200 BrusselsBelgium Department of Gastroenterology and Hepatology Dartmouth-Hitchcock Medical CenterOne Medical Center DriveLebanonNH 03756United States Department of Gastroenterology Istituto Clinico Humanitas20089 RozzanoItaly Department of Internal Medicine Division of Gastroenterology and HepatologyJohns Hopkins HospitalBaltimoreMD 21205United States Wolfson Unit for Endoscopy St.Mark's HospitalHarrow HA1 3UJUnited Kingdom Department of Internal Medicine Division of GastroenterologyBaylor University Medical CenterDallasTX 75246United States

AIM:To determine which patients might benefit most from retrograde viewing during colonoscopy through subset analysis of randomized,controlled trial ***:The Third Eye Retroscope Randomized Clinical Evaluation(TERRACE) was a randomized,controlled,multicenter trial designed to evaluate the efficacy of a retrograde-viewing auxiliary imaging device that is used during colonoscopy to provide a second video image which allows viewing of areas on the proximal aspect of haustral folds and flexures that are difficult to see with the colonoscope's forward *** performed a post-hoc analysis of the TERRACE data to determine whether certain subsets of the patient population would gain more benefit than others from use of the *** were patients scheduled for colonoscopy for screening,surveillance or diagnostic workup,and each underwent same-day tandem examinations with standard colonoscopy(SC) and Third Eye colonoscopy(TEC),randomized to SC followed by TEC or vice ***:Indication for colonoscopy was screening in 176/345 subjects(51.0%),surveillance after previous polypectomy in 87(25.2%) and diagnostic workup in 82(23.8%).In 4 subjects no indication was *** reported overall results had shown a net additional adenoma detection rate(ADR) with TEC of 23.2% compared to *** risk(RR) of missing adenomas with SC vs TEC as the initial procedure was 1.92(P = 0.029).Post-hoc subset analysis shows additional ADRs for TEC compared to SC were 4.4% for screening,35.7% for surveillance,55.4% for diagnostic and 40.7% for surveillance and diagnostic *** RR of missing adenomas with SC vs TEC was 1.11(P = 0.815) for screening,3.15(P = 0.014) for surveillance,8.64(P = 0.039) for diagnostic and 3.34(P = 0.003) for surveillance and diagnostic *** a multivariate Poisson regression suggested gender as a possibly significant factor,subset analysis showed that the difference between genders was not statistically ***

关键词： Colonoscopy Colorectal cancer Adenomas Miss rates Retrograde-viewing

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经口经胃腹部手术

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胃肠病学 2006年第6期11卷 379-381页

作者： Chung-Wang KO anthony n kalloo 蒋晓玲（译）萧树东（校） Division of Gastroenterology and Hepatology Johns Hopkins Hospital Baltimore Maryland USA 不详

一、简介随着内镜治疗技术的发展,传统外科手术处理疾病的方式发生了变革.由于具有低侵袭性的特点,内镜治疗已成为某些疾病,如胆总管结石和早期胃癌的标准治疗手段.内镜治疗的范围已扩展至腹膜腔.操作时发生穿孔有引发腹膜炎的危险,是... 详细信息

一、简介随着内镜治疗技术的发展,传统外科手术处理疾病的方式发生了变革.由于具有低侵袭性的特点,内镜治疗已成为某些疾病,如胆总管结石和早期胃癌的标准治疗手段.内镜治疗的范围已扩展至腹膜腔.操作时发生穿孔有引发腹膜炎的危险,是内镜操作最严重的并发症;因此,如何安全地通过胃壁行可曲式内镜操作是我们面临的主要挑战[1].自2000年首次报道内镜经胃腹腔镜检查获成功以来,研究者们对这一问题十分关注,并进行了大量探索和研究[2～5].本文对经胃腔外手术或天然入口穿腔内镜手术(nOTES)概念的发展和现状作一讨论.

关键词：早期胃癌腹部手术内镜治疗技术经口内镜操作胆总管结石腹腔镜检查手术处理传统外科低侵袭性

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Mini-laparoscopy in the endoscopy unit:Safety and outcomes in over one thousand patients

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World Journal of Gastrointestinal Endoscopy 2011年第1期3卷 6-10页

作者： Arthur Hoffman Fareed Rahman Sarah Prengel Marcus Schuchmann Martin Gotz Markus Moehler Peter Robert Galle Ziping Li anthony nicolas kalloo Ralf Kiesslich First Department of Internal Medicine Johannes Gutenberg University Mainz Department of Gastroenterology and Hepatology Johns Hopkins University

AIM:To investigate the safety of consecutive mini-lapar oscopy guided liver biopsies for the diagnosis and staging of liver diseases. METHODS: In this study we retrospectively analyzed the safety of mini-laparoscopic liver biopsy performed in an endoscopy unit in 1071 patients. We measured the incidence of bleeding and evaluated the management and outcome of bleeding *** viral hepatitis and autoimmune liver disease. 250 patients had macroscopically and histologically proven cirrhosis. 13 patients had no pathological f indings. 33% of all patients had bleeding that required argon plasma coagulation of the puncture site during laparoscopy. Signif icant bleeding occurred more often in patients with liver cirrhosis compared to non-cirrhotic liver dise ases but was effectively treated with laparoscopic coag ulation. COnCLUSIOn: In conclusion, mini-laparoscopy liver biopsy can be performed safely and effectively in high risk patients with advanced liver disease; mini-lapar osc opy with liver biopsy can be done safely in an endos copy unit.

关键词： Mini-laparoscopy Cirrhosis Argon plasma coagulation

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