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Management of pancreaticobiliary disease using a new intra-ductal endoscope:The Texas experience

World Journal of Gastroenterology 2009年第11期15卷 1353-1358页

作者： Douglas S Fishman Paul R Tarnasky Sandeep N Patel isaac raijman Texas Children’s Hospital Section of Pediatric Gastroenterology and NutritionBaylor College of Medicine6621 Fannin StreetHoustonTX 77030United States Digestive Health Associates Methodist Pavilion II 221 West Colorado Blvd.DallasTX 75208-2359United States Division of Gastroenterology and Nutrition The University of Texas Health Science Center at San Antonio7703 Floyd Curl Drive San AntonioTX 78229-3900United States Digestive Associates of Houston 6620 Main Street.HoustonTX 77030United States

AIM:To evaluate a new single-operator mini-endoscope, Spyglass,for its performance,feasibility and safety in the management of pancreaticobiliary disease. METHODS:In a multicenter retrospective analysis of patients undergoing intraductal endoscopy,we evaluated 128 patients(71 men,mean age 57.6 years).Indications were therapeutic(TX)in 72(56%) and diagnostic(DX)in 56(44%). RESULTS:Peroral endoscopy was performed in 121 and percutaneous in *** indications included CBD stones in 41,PD stones in six,and biliary strictures in *** indications included abnormal LFT’s in 15, abnormal imaging in 38 and cholangiocarcinoma staging in *** of the stone(s)was considered good in 31,fair in six,and poor in four. Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients.A holmium laser was used successfully in three *** clearance was achieved in 37 patients after one procedure and in four patients after two *** of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/*** the modified patients,no diagnosis was available in *** demonstrated malignancy in 8/17 and non-malignancy in *** pathology by imaging studies and abnormal LFT’s was modified in 43/63(66%).Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/*** was no morbidity associated with the use of Spyglass. CONCLUSION:Spyglass Spyscopeis a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.

关键词： Intra-ductal endoscopy Choledochoscopy Cholangiopancreatoscopy Endoscopic retrogradecholangiopancreatography Biliary disease Sclerosingcholangitis Cholangiocarcinoma Lithotripsy Pancreaticdisease Spyglass

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Diagnostic and therapeutic role of endoscopic retrograde cholangiopancreatography in biliary rhabdomyosarcoma

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World Journal of Gastroenterology 2008年第30期14卷 4823-4825页

作者： Ryan W Himes isaac raijman Milton J Finegold Heidi V Russell Douglas S Fishman Section of Pediatric Gastroenterology Hepatology & Nutrition Baylor College of Medicine Texas Children's Hospital Digestive Disease Associates of Houston Department of Pathology Baylor College of Medicine Texas Children’s Hospital Texas Children’s Cancer Center Baylor College of Medicine Section of Pediatric Gastroenterology Hepatology & Nutrition Baylor College of Medicine Texas Children’s Hospital

Biliary rhabdomyosarcoma (BRMS) is an uncommon childhood malignancy which has been managed surgically. We present a case of a 3-year-old boy with BRMS, in whom endoscopic retrograde cholangiopancreatography (ERCP) was successfully used both diagnostically and therapeutically, thus obviating the need for surgery and its attendant risks of morbidity and mortality. We conclude that ERCP is an effective alternative to surgery for BRMS in some patients.

关键词： Pancreaticobiliary Malignancy Pediatric Endoscopic retrograde cholangiopancreatography Jaundice

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Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention

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World Journal of Gastrointestinal Endoscopy 2016年第11期8卷 425-432页

作者： Douglas S Fishman Bruno P Chumpitazi isaac raijman Cynthia Man-Wai Tsai E O’Brian Smith Mark V Mazziotti Mark A Gilger Section of Pediatric Gastroenterology Hepatology and Nutrition Baylor College of Medicine Texas Children’s Hospital Houston TX 77030 United States Digestive Associates of Houston Houston TX 77098 United States Department of Surgery Section of Pediatric Surgery Baylor College of Medicine Houston TX 77030 United States Department of Surgery Section of Pediatric Surgery Baylor College of MedicineHouston TX 77030 United States Department of Pediatrics Baylor College of Medicine Children’s Hospital of San Antonio San Antonio TX 78207 United States

AIM:To assess pediatric patients for *** applied current adult guidelines to identify predictivefactors in ***:A single-center retrospective analysis was performed at a tertiary children's *** evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography(ERCP) for suspected *** were stratified into those with common bile duct stones(CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy(ASGE) guidelines(Very Strong and Strong criteria) for suspected ***:CBDS were identified in 84% at the time of *** ultrasound identified CBDS in 36% of *** bilirubin ≥ 0.5 mg/d L was an independent risk factor for CBDS(P = 0.003).The Very Strong(59.5%) and Strong(48.6%) ASGE criteria identified the majority of patients(P = 0.0001).A modified score using conjugated bilirubin had a higher sensitivity(81.2% vs 59.5%) and more likely to identify a stone than the standard criteria,odds ratio of 25.7 compared to *** aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25,***:Current adult guidelines identified the majority of pediatric patients with CBDS,but specific pediatric guidelines may improve detection,thus decreasing risks and unnecessary procedures.

关键词： Endoscopic retrograde cholangiography Pediatric Endoscopy Choledocholithiasis Children Gallstones Abdominal ultrasound

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