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Impact of periampullary diverticula on the outcome and fluoroscopy time in endoscopic retrograde cholangiopancreatography

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Hepatobiliary & Pancreatic Diseases International 2013年第4期12卷 408-414页

作者： panagiotis katsinelos Grigoris Chatzimavroudis Kostas Tziomalos Christos Zavos Athanasios Beltsis Georgia Lazaraki Sotiris Terzoudis Jannis Kountouras Department of Endoscopy and Motility Unit G. Gennimatas General Hospital School of Medicine Aristotle University of Thessaloniki Ippokration HospitalThessaloniki Greece Department of Internal Medicine School of Medicine Aristotle University of Thessaloniki Ippokration HospitalThessaloniki Greece

BACKGROUND: It is unclear whether the presence of periampullary diverticula (PAD) affects technical success and complication rates during endoscopic retrograde cholangio- pancreatography (ERCP). Moreover, the impact of PAD on fluoroscopy duration is still unknown. The present study aimed to investigate the success rate and difficulty of common bile duct (CBD) cannulation, post-procedure complications and fluoroscopy duration in patients with and without PAD. METHODS: Patients from January 2008 to December 2010 with PAD (group A) and without PAD (group B) and similar indications for therapeutic ERCP were prospectively compared. The comparison included patient characteristics, findings of ERCP, and details of procedure and fluoroscopy time. The influence of papilla’s location with respect to the diverticulum on procedure was also investigated. RESULTS: A total of 428 consecutive patients who had undergone therapeutic ERCP for similar indications were divided in two groups according to the presence (group A, 107 patients) or absence (group B, 321 patients) of PAD. The mean age and ASA score of the patients with PAD were significantly higher than those patients without PAD. The main indication was choledocholithiasis. Successful final CBD cannulation was achieved in 97.20% of the patients in group A vs 99.69% in group B (P=0.05). CBD diameter, number of stones and the largest stone size were significantly higher in group A thangroup B (P<0.001). Complete clearance of the CBD after the first attempt was achieved in 85.86% and 94.75% of the patients in groups A and B, respectively (P=0.03). In both groups, the time needed to complete the procedure and fluoroscopy time was significantly longer in patients with PAD (22.87 vs 18.99 minutes, P<0.001; 76.51 vs 47.42 seconds, P<0.001). There was no significant difference between the two groups in the complication rate. The type of papilla’s location with respect to the diverticulum did not influence the total cannulati

关键词： endoscopic retrograde cholangiopancreatography anatomy ampulla of Vater

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 tissue 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） too. 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 offer a significant healing rate for acute anal fissure and might prevent its evolution to chronicity.

关键词： Acute anal fissure Nifedipine Calcium channel blockers Topical treatment

Pancreatitis complicating mucin-hypersecreting common bile duct adenoma

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World Journal of Gastroenterology 2006年第30期12卷 4927-4929页

作者： panagiotis katsinelos George Basdanis Grigorios Chatzimavroudis Giorgia Karagiannoulou Taxiarchis katsinelos George Paroutoglou Basilios Papaziogas George Paraskevas Department of Endoscopy and Motility Unit "G.Gennimatas" Hospital Ethnikis Aminis 41 Thessaloniki 54635 Greece Department of Pathology Aristotle University of Thessaloniki Greece

Villous adenomas of the bile ducts are extremely uncommon. We describe a 58-year-old man presenting with clinical signs and laboratory findings of acute pancreatitis and obstructive jaundice. Preoperative investigation demonstrated a dilated papillary orifice with mucus exiting （fish-mouth sign） and a filling defect in the distal common bile duct. He underwent a modified Whipple operation and histological examination of the surgical specimen showed villous adenoma with rich secretion of mucus.

关键词： Villous adenoma Common bile duct Endoscopic retrograde cholangiopancreatography

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： Biliary cast Ursodeoxycholic acid Endoscopic retrograde cholangiopancreatography

Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips

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World Journal of Gastroenterology 2005年第39期11卷 6232-6234页

作者： panagiotis katsinelos George Paroutoglou Basilios Papaziogas Athanasios Beltsis Stavros Dimiropoulos Konstantinos Atmatzidis Department of Endoscopy and Motility Unit "G.Gennimatas" Hospital Ethnikis Aminis 4154635 ThessalonikiGreece 2nd Surgical Clinic "G.Gennimatas" Hospital Aristotle University of ThessalonikiEthnikis Aminis 4154635 ThessalonikiGreece

Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single *** was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d *** of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.

关键词： Endoclipping Duodenal perforation Endoscopic sphincterotomy

Partially covered vs uncovered sphincterotome and postendoscopic sphincterotomy bleeding

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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

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 dilation. METHODS： 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 score. The median dysphagia-free duration was calculated by Kaplan-Meier analysis. RESULTS： 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 5-97mo）, 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 dysphagia- free duration by Kaplan-Neier analysis was 78%, 61% and 58.3% after 5, 10 and 15 years respectively. CONCLUSION： Balloon dilation is a safe and effective treatment for primary achalasia. Post-dilation LES pressure estimation may be useful in assessing response. 2005 The *** Press and Elsevier Inc. All rights reserved.

关键词： Pneumatic dilation Primary achalasia Esophagoscopy Barium esophagogram, Manometry

Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis

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World Journal of Gastroenterology 2009年第48期15卷 6075-6079页

作者： panagiotis katsinelos Jannis Kountouras Grigoris Chatzimavroudis Christos Zavos Ioannis Pilpilidis Kostas Fasoulas George Paroutoglou Departmentof Endoscopy and Motility Unit Central HospitalThessalonikiGreece Second Departmentof Internal Medicine Aristotle University of ThessalonikiHippokration Hospital

AIM:To detect the prevalence of small bowel polyps by wireless capsule endoscopy(WCE)in patients with familial adenomatous polyposis(FAP).METHODS:We examined prospectively 14 patients with FAP to assess the location,size and number of small-intestinal ***'age,sex,years of observation after surgery,type of surgery,duodenal polyps and colorectal cancer at surgery were ***:During WCE,polyps were detected in 9/14(64.3%)*** adenomatous polyps were found in nine(64.3%)patients,and jejunal and ileal polyps in seven(50%)and eight(57.1%),*** Spigelman stage of duodenal polyposis was associated with the presence of jejunal and ileal *** of the ampulla of Vater was not achieved with ***,the findings of WCE had no immediate impact on the further clinical management of FAP *** procedure-related complications were observed in the ***:WCE is a promising noninvasive new method for the detection of small-intestinal *** investigation is required to determine which phenotype of FAP is needed for surveillance with WCE.

关键词： Wireless capsule endoscopy Familial adenomatous polyposis Intestinal polyps Duodenal neoplasms Adenoma

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： Endoscopic treatment Dieulafoy lesion Gastrointestinal tract