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Partially covered vs uncovered sphincterotome and postendoscopic sphincterotomy bleeding

World Journal of Gastroenterology 2010年第40期16卷 5077-5083页

作者： Panagiotis Katsinelos George Paroutoglou jannis kountouras Grigoris Chatzimavroudis Christos Zavos Sotiris Terzoudis Taxiarchis Katsinelos Kostas Fasoulas George Gelas George Tzovaras Ioannis Pilpilidis Department of Endoscopy and Motility Unit Medical School Aristotle University of Thessaloniki G. Gennimatas General Hospital Department of Gastroenterology University Hospital of Thessaly 2nd Department of Internal Medicine Medical School Aristotle University of Thessaloniki Ippokration Hospital

AIM: To prospectively compare partially covered vs uncovered sphincterotome use on post-endoscopic biliary sphincterotomy (ES) hemorrhage and other complications. METHODS: All patients referred for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) were randomly assigned to undergo ES either with a partially covered or an uncovered sphincterotome. Both patient and technical risk factors contributing to the development of post-ES bleeding were recorded and analyzed. The characteristics of bleeding was recorded during and after ES. Other complications were also compared. RESULTS: Three-hundred and eighty-seven patients were recruited in this study; 194 patients underwent ES with a partially covered sphincterotome and 193 with conventional uncovered sphincterotome. No statistical difference was noted in the baseline characteristics and risk factors for post-ES induced hemorrhage between the 2 groups. No significant difference in the incidence and pattern of visible bleeding rates was found between the 2 groups (immediate bleeding in 24 patients with the partially covered sphincterotome vs 19 patients with the uncovered sphincterotome, P = 0.418). Delayed bleeding was observed in 2 patients with a partially covered sphincterotome and in 1 patient with an uncovered sphincterotome (P = 0.62). No statistical difference was noted in the rate of other complications. CONCLUSION: The partially covered sphincterotome was not associated with a lower frequency of bleeding. Also, there was no difference in the incidence of other significant complications between the 2 types of sphincterotome.

关键词： Sphincterotome Endoscopic sphincterotomy Hemorrhage Complications

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Endoscopic management of occluded biliary uncovered metal stents:A multicenter experience

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World Journal of Gastroenterology 2011年第1期17卷 98-104页

作者： Panagiotis Katsinelos Athanasios Beltsis Grigoris Chatzimavroudis Dimitris Paikos George Paroutoglou Dimitris Kapetanos Sotiris Terzoudis Georgia Lazaraki Ioannis Pilpilidis Kostas Fasoulas Stefanos Atmatzidis Christos Zavos jannis kountouras Department of Endoscopy and Motility Unit "G. Gennimatas" General Hospital 55132 Thessaloniki Greece Department of Gastroenterology Theagenion Anticancer Hospital 54642 Thessaloniki Greece Department of Gastroenterology University Hospital of Thessaly 41222 Larissa Greece Department of Gastroenterology "G. Papanikolaou" General Hospital 55236 Thessaloniki Greece 2nd Department of Internal Medicine Medical School Aristotle University of Thessaloniki Ippokration Hospital 54642 Thessaloniki Greece

AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs) that had been placed for palliative treatment of unresectable malignant biliary ***:A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded *** technical success of performed treatment in occluded SEMSs,the patency of the stent,the need for re-intervention and the financial costs of each treatment were ***:Fifty four patients were included in the analysis;21 received Hanaro,19 Wallstent and 14 *** the relief of obstruction,a plastic stent was inserted in 24 patients,a second SEMS in 25 and mechanical cleaning was performed in 5 *** overall median second patency rates between second SEMSs and plastic stents did not differ(133 d for SEMSs vs 106 d for plastic stents;P = 0.856).Similarly,no difference was found between the overall survival of SEMS and plastic stent groups,and no procedure-related complications *** cost analysis showed that successive plastic stenting was a cost-saving strategy at least in ***:Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs;insertion of plastic stents appears to be the most cost-effective strategy.

关键词：金属支架闭塞内镜多中心塑料支架胆管理发 SEMS

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Combined endoscopic and ursodeoxycholic acid treatment of biliary cast syndrome in a non-transplant patient

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World Journal of Gastroenterology 2008年第33期14卷 5223-5225页

作者： Panagiotis Katsinelos jannis kountouras Grigoris Chatzimavroudis Christos Zavos Ioannis Pilpilidis George Paroutoglou Department of Endoscopy and Motility Unit Central HospitalThessaloniki 54635 Greece Department of Gastroenterology Second Medical Clinic Aristotle University of Thessaloniki Ippokration HospitalThessaloniki 54635 Greece

A 76-year-old diabetic man underwent cholecystectomy for gangrenous calculous cholecystitis. His postoperative course was complicated by the development of Candida albicans esophagitis necessitating antifungal therapy, and total parenteral nutrition (TPN) for 15 d. Seven weeks after cholecystectomy, he presented with cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated extrahepatic filling defects. Despite endoscopic extraction of a biliary cast, cholestasis remained unchanged. Oral administration of ursodeoxycholic acid (UDCA), 750 mg/d, resulted in normalization of liver function tests. We, therefore, propose for the f irst time, combined endoscopic plus UDCA treatment for the management of biliary cast syndrome.

关键词：消化系统疾病内窥镜检查胆汁疾病肠外营养

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Long-term results of pneumatic dilation for achalasia: A15 years' experience

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World Journal of Gastroenterology 2005年第36期11卷 5701-5705页

作者： Panagiotis Katsinelos jannis kountouras George Paroutoglou Athanasios Beltsis Christos Zavos Basilios Papaziogas Kostas Mimidis Department of Endoscopy and Motility Unit Central Hospital Thessaloniki Greece Department of Medicine Second Medical Clinic Aristotle University of Thessaloniki Ippokration Hospital Thessaloniki Greece

AIM: Although most patients with achalasia respond to pneumatic dilation, one-third experienced recurrence, and prolonged follow-up studies on parameters associated with various outcomes are scanty. In this retrospective study, we reported a 15-years' experience with pneumatic dilation treatment in patients with primary achalasia, and determined whether previously described predictors of outcome remain significant after endoscopic ***: Between September 1989 and September 2004, 39 consecutive patients with primary symptomatic achalasia (diagnosed by clinical presentation, esophagoscopy,barium esophagogram, and manometry) who received balloon dilation were followed up at regular intervals in person or by phone interview. Remission was assessed by a structured interview and a previous symptoms *** median dysphagia-free duration was calculated by Kaplan-Meier ***: Symptoms were dysphagia (n = 39, 100%),regurgitation (n =23, 58.7%), chest pain (n = 4, 10.2%),and weight loss (n = 26, 66.6%). A total of 74 dilations were performed in 39 patients; 13 patients (28%) underwent a single dilation, 17 patients (48.7%) required a second procedure within a median of 26.7 mo (range 5-97 mo), and 9 patients (23.3%) underwent a third procedure within a median of 47.8 mo (range 37-120 mo). Post-dilation lower esophageal sphincter (LES) pressure, assessed in 35 patients, has decreased from a baseline of 35.8±10.4-10.0±7.1 mmHg after the procedure. The median follow-up period was 9.3 years (range 0.5-15 years). The dysphagiafree duration by Kaplan-Meier analysis was 78%, 61%and 58.3% after 5, 10 and 15 years ***: Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response.

关键词：气囊扩张压力测量法食管弛缓不能治疗方法

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Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity

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World Journal of Gastroenterology 2006年第38期12卷 6203-6206页

作者： Panagiotis Katsinelos jannis kountouras George Paroutoglou Athanasios Beltsis Grigoris Chatzimavroudis Christos Zavos Taxiarchis Katsinelos Basilis Papaziogas Department of Endoscopy and Motility Unit Central Hospital Thessaloniki Greece Department of Gastroenter- ology Second Medical Clinic Aristotle University of Thessaloniki Ippokration Hospital Thessaloniki Greece

AIM: To investigate the efficacy of topical application of 0.5% nifedipine ointment in healing acute anal fissue and preventing its progress to chronicity. METHODS: Thirty-one patients (10 males, 21 females) with acute anal fissure from September 1999 to January 2005 were treated topically with 0.5% nifedipine ointment (t.i.d.) for 8 wk. The patients were encouraged to follow a high-fiber diet and assessed at 2, 4 and 8 wk post-treatment. The healing of fissure and any side effects were recorded. The patients were subsequently followed up in the outpatient clinic for one year and contacted by phone every three months thereafter, while they were encouraged to come back if symptoms recurred. RESULTS: Twenty-seven of the 31 patients completed the 8-wk treatment course, of them 23 (85.2%) achieved a complete remission indicated by resolution of symptoms and healing of fissure. Of the remaining four unhealed patients (14.8%), 2 opted to undergo lateral sphincterotomy and the other 2 to continue therapy for four additional weeks, resulting in healing of fissure. All the 25 patients with complete remission had a mean follow-up of 22.9 ± 14 (range 6-52) mo. Recurrence of symptoms occurred in four of these 25 patients (16%) who were successfully treated with an additional 4-wk course of 0.5% nifedipine ointment. Two of the 27 (7.4%) patients who completed the 8-wk treatment presented with moderate headache as a side effect of nifedipine. CONCLUSION: Topical 0.5% nifedipine ointment, used as an agent in chemical sphincterotomy, appears to offera significant healing rate for acute anal fissure and might prevent its evolution to chronicity.

关键词：肛门疾病硝苯地平钙元素治疗

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Cecal lipoma with pseudomalignant features: A case report and review of the literature

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World Journal of Gastroenterology 2007年第17期13卷 2510-2513页

作者： Panagiotis Katsinelos Grigoris Chatzimavroudis Christos Zavos Ioannis Pilpilidis Georgia Lazaraki Basilis Papaziogas George Paroutoglou jannis kountouras Dimitris Paikos Department of Endoscopyand Motility Unit Central Hospital Thessaloniki Greece 2nd SurgicaClinic Medical School Aristotle University of Thessaloniki Greece 2nd Clinic of InternaMedicine Medical School Aristotle University of ThessalonikiThessaloniki Greece

Colonic lipoma is a well-documented benign neoplasia, endoscopically appearing as a smooth round yellowish polyp with a thick stalk or broad-based attachment. We describe a 63-year old woman with persistent abdominal pain, in whom colonoscopy revealed a cecal mass with malignant features. Based on the colonoscopy findings, right hemicolectomy was laparoscopically performed for a presumptive diagnosis of a cecal adenocarcinoma, but histological examination revealed a colonic lipoma with overlying mucosal ulceration.

关键词：盲肠脂肪瘤伪恶性特征病例报告文献综述

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Endoscopic treatment and follow-up of gastrointestinal Dieulafoy's lesions

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World Journal of Gastroenterology 2005年第38期11卷 6022-6026页

作者： Panagiotis Katsinelos George Paroutoglou Kostas Mimidis Athanasios Beltsis Basilios Papaziogas George Gelas Yiannis kountouras Department of Endoscopy and Motility Unit 2nd Surgical Clinic 2nd Department of Internal Medicine

AIM: To investigate retrospectively the clinical and endoscopic features of bleeding Dieulafoy's lesions and to assess the short- and long-term effectiveness of endoscopic ***: Twenty-three patients who had gastrointestinal bleeding from Dieulafoy's lesions underwent endoscopic therapy. Demographic data, mode of presentation, riskfactors for gastrointestinal bleeding, blood transfusion requirements, endoscopic findings, details of endoscopic therapy, recurrence of bleeding, and mortality rates were collected and analyzed ***: Hemostasis was attempted by dextrose 50% plus epinephrine in 10 patients, hemoclipping in 8 patients,heater probe in 2 patients and ethanolamine oleate in 2 patients. Comorbid conditions were present in 17 patients (74%). Overall permanent hemostasis was achieved in 18 patients (78%). Initial hemostasis was successful with no recurrent bleeding in patients treated with hemoclipping, heater probe or ethanolamine injection. In the group of patients who received dextrose 50% plus epinephrine injection treatment, four (40%) had recurrent bleeding and one (10%) had unsuccessful initial *** the four patients who had rebleeding, three had unsuccessful hemostasis with similar treatment. Surgical treatment was required in five patients (22%) owing to uncontrolled bleeding, recurrent bleeding with unsuccessful retreatment and inability to approach the lesion. One patient (4.3%) died of sepsis after operation during hospitalization. There were no side-effects related to endoscopic therapy. None of the patients in whom permanent hemostasis was achieved presented with rebleeding from Dieulafoy's lesion over a mean long-term follow-up of 29.8 ***: Bleeding from Dieulafoy's lesions can be managed successfully by endoscopic methods, which should be regarded as the first choice. Endoscopic hemoclipping therapy is recommended for bleeding Dieulafoy's lesions.

关键词：内窥镜胃疾病肠疾病病理机制临床表现

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INCREASED LEVELS OF HELICOBACTER PYLORI IGG ANTIBODIES IN THE AQUE- OUS AND SERUM OF PATIENTS WITH PRIMARY OPEN-ANGLE AND EXFOLIA-TION GLAUCOMA

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国际眼科杂志 2003年第1期3卷 46-46页

作者： J.kountouras N.Mylopoulos J.kountouras N.Mylopoulos A.G.P.Konstas C.Zavos D.Chatzopoulos A.Boukla De-partment of Gastroenterology 2nd Medical Clinic Aristotle Uni-versity of ThessalonikiIppokration HospitalUniversity Department of Ophthalmology Aristotle University of Thessa-loniki GreeceUniversity Department of Ophthalmology Aristotle University of Thessa-loniki GreeceUniversity Department of Ophthalmology Aristotle University of Thessa-loniki GreeceDe-partment of Gastroenterology 2nd Medical Clinic Aristotle Uni-versity of ThessalonikiDe-partment of Gastroenterology 2nd Medical Clinic Aristotle Uni-versity of ThessalonikiDe-partment of Gastroenterology 2nd Medical Clinic Aristotle Uni-versity of Thessaloniki

Objective: We investigated the levels of anti-H. pylori specific IgG antibodies in the aqueous serum of patients with POAG and patients with exfoliation glaucoma (XFG) and compared these with age-matched patients with cataract Design: Prospective, nonrandomized, consecutive comparative study. Participants: 26 patients with POAG, 27 patients with XFG, and 31

关键词：血清房水幽门螺杆菌抗体水平开角型青光眼脱皮性青光眼病原

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口服大剂量别嘌呤醇可预防ERCP后胰腺炎的发生:一项前瞻性、随机、双盲对照试验

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世界核心医学期刊文摘（胃肠病学分册） 2005年第8期1卷 34-34页

作者： Katsinelos P kountouras J Chatzis J 陈云茹 Aristotle Uni versity of Thessaloniki 8 Fanariou St551 33 Thessaloniki Macedonia Greece.Dr

Background: Pancreatitis is the most common major complication of diagnostic a nd therapeutic ERCP. Allopurinol,a xanthine oxidase inhibitor that blocks genera tion of oxygen-derived free radicals, potentially may prevent post-ERCP pancre atitis. This study assessed the efficacy of high-dose oral allopurinol for prev ention of post-ERCP pancreatitis. Methods:A prospective, double-blind, placebo -controlled trial was conducted in 250 patients undergoing ERCP. Patients were randomized to receive allopurinol (600 mg) or placebo orally at 15 and 3 hours b efore the procedure. Patients were clinically evaluated, and serum amylase level s were determined before ERCP and at 6 and 24 hours thereafter. Standardized cri teria were used to diagnose and to grade the severity of post-ERCP pancreatitis . Results: A total of 243 patients were included in the analysis. The two groups were similar with regard to age;gender; underlying disease; indication for trea tment; ERCP findings; and type of treatment, except for biliary sphincterotomy.O nly 43 patients in the allopurinol group underwent biliary sphincterotomy vs. 87 in the placebo group (p< 0.001).The frequency of acute pancreatitis was signifi cantly lower in the allopurinol vs. the placebo group in the final multinomial r egression analysis: allopurinol group, 4/125 (3.2%), with all 4 cases graded as mild, vs. placebo group, 21/118 (17.8%),of which 8/118 (6.8%) were graded as mild, 11/118 (9.3%) as moderate, and 2/118 (1.6%) as severe with fatal outcome (p< 0.001). The protective effect of allopurinol was also apparent in the diagn ostic ERCP and the biliary sphincterotomy subgroups when the frequency of post- ERCP pancreatitis was analyzed after stratification by procedure. The mean durat ion of hospitalization for pancreatitis was significantly shorter in the allopur inol compared with the placebo group (2.5 vs. 5.67 days;p < 0.001). Conclusions: Pretreatment with high-dose, orally administered allopurinol decreases the fr

关键词：别嘌呤醇双盲对照血清淀粉酶安慰剂对照治疗指征潜在疾病标化于术临床评估亚群

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幽门螺杆菌感染与阿尔茨海默病的关系

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世界核心医学期刊文摘(神经病学分册) 2006年第10期 51-51页

作者： kountouras J. Tsolaki M. Gavalas E. 刘凯 8 Fanariou St. Byzantio 551 33 Thessaloniki Greece Dr.

The authors investigated the association between Helicobacter pylori infection (Hp- I) and Alzheimer disease (AD) by using histology for diagnosis of Hp- I. Fifty patients with AD and 30 iron deficiency anemic control participants without AD were included. The histologic prevalence of Hp- I was 88% in patients with AD and 46.7% in controls (p < 0.001).

关键词：阿尔茨海默病幽门螺杆菌感染

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