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C Feretis,
D Kalantzopoulos,
P Koulouris,
C Kolettas,
F Archontovasilis,
S Chandakas,
H Patsea,
A Pantazopoulou,
M Sideris,
A Papalois,
K Simopoulos,
E Leandros
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ABSTRACT: An incisionless endoscopic peroral transgastric approach to the peritoneal cavity has shown promise in animals as a potentially less invasive form of surgery. We present our experience with various endoscopic peroral transgastric procedures, reporting on the technical aspects and challenges that arose.
The following procedures were performed in 10 anesthetized pigs using a double-channel endoscope: peritoneoscopy (10 pigs), liver biopsy (one pig), cholecystectomy (six pigs), fallopian tube excision (one pig), and hysterectomy (one pig).
All the procedures were accomplished successfully. There were six minor intraoperative complications. Complete gastric cleansing and elimination of all bacteria was found to be impossible to achieve in the porcine model. Overinflation was a common problem. The lack of adequate endoscope support was a major limitation. Safe closure of the gastrotomy incision was difficult using the available clipping devices. Six pigs made an uncomplicated recovery after a follow-up period of 4-6 weeks. Subsequent pathological examination revealed deep gastric ulceration in one animal and a gastric wall abscess in another.
Peroral transgastric surgery is technically feasible and safe in a porcine model. Although all the procedures were performed successfully, the study highlights some technical difficulties and illustrates the need for major technical innovations and extensive animal studies in order to evaluate the merits of incisionless surgery.
Endoscopy 06/2007; 39(5):394-400. · 5.21 Impact Factor
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ABSTRACT: The implantation of expandable microballoons has proved successful for the treatment of stress urinary incontinence. This led us to test its effectiveness in the treatment of severe fecal incontinence.
Six patients (four male), of average age of 43 (range, 29-60) years, with severe fecal incontinence, underwent implantation of expandable microballoons in the submucosa of the anal canal. The implantation was performed under intravenous sedation as an outpatient procedure. Anal manometry, endosonography, and incontinence assessment with a scoring system were performed before and after the implantation.
With a mean follow-up of 8.6 (range, 7-12) months, the incontinence scores improved in all patients from an average of 16.16 (standard deviation: +/- 1.6) before the implantation to an average of 5 (standard deviation: +/- 1.26) after the procedure. The anal pressure at rest was not improved in any patient (mean: 50.16 before treatment to a mean of 53 after treatment). No significant adverse events were associated with the procedure, and no serious postimplantation complications were noted.
Anal implantation of expandable microballoons seems to be a simple, safe, and effective method that restores the fecal continence without hindering normal defecation.
Diseases of the Colon & Rectum 12/2001; 44(11):1605-9. · 3.13 Impact Factor
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ABSTRACT: A gelatinous implant containing polymethylmethacrylate (PMMA) beads is successfully used to augment the diminished thickness of the chorium in patients with skin defects and wrinkles. The aim of the present study was to determine whether submucosal injection of PMMA microspheres into the lower esophageal folds decreases the severity of symptoms and acid reflux in patients with GERD.
Endoscopic submucosal implantation of PMMA was carried out in 10 patients with GERD who were either refractory to or dependent on proton pump inhibitors. Symptom severity score, 24-hour pH monitoring, upper GI endoscopy, and EUS were performed to evaluate the efficacy of implantation.
A significant decrease in the symptom severity score and mean total time with esophageal pH less than 4 was noted after the implantation of PMMA (p < 0.05). Seven of 10 patients were taking no medication after PMMA implantation. There were no serious procedure-related complications.
Endoscopic implantation of PMMA into the submucosa of the lower esophageal folds may be a new method for treating GERD. Further studies are required to determine the long-term efficacy of the procedure.
Gastrointestinal Endoscopy 05/2001; 53(4):423-6. · 4.88 Impact Factor
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ABSTRACT: The risks of palliative operative intervention of gastric outlet obstruction for advanced pancreatic head carcinoma has been reported to be quite high. The present study reports the results of attempted endoscopic palliation of duodenal obstruction in these patients.
Ten patients with endoscopically documented malignant duodenal strictures from pancreatic head carcinoma in whom self-expandable endoprostheses were placed are retrospectively analyzed. In three patients with jaundice, biliary stents were also placed. Standard esophageal type (not membrance coated) Wallstent self-expandable endoprostheses were used.
Gastric outlet obstruction was relieved in all patients after implantation of duodenal endoprostheses, and jaundice was palliated in those with additional biliary obstruction after bile duct stenting. One case of gastric ulceration was the major complication. No recurrence of gastric outlet obstruction was noted in the follow-up period of 1 to 5 months.
The preliminary data suggest that self-expandable duodenal endoprostheses can effectively relieve gastric outlet obstruction in patients with advanced pancreatic head carcinoma.
Gastrointestinal Endoscopy 09/1997; 46(2):161-5. · 4.88 Impact Factor
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ABSTRACT: When large-bowel obstruction supervenes in patients with rectal tumor recurrence and extensive nonresectable disease, a proximal diverting colostomy may be indicated. In this study, nonsurgical palliation of the obstruction was attempted by inserting self-expandable endoprostheses to bridge the stenotic lesion. The endoprostheses were positioned in two patients with large-bowel obstruction due to recurrent stenotic tumor, and extensive disease excluding palliative resection. Self-expandable endoprostheses with inner diameters of 18 mm and 22 mm were successfully inserted under endoscopic and radiographic control. Proper expansion of the endoprostheses was achieved in both patients, resulting in immediate decompression of the bowel and lasting relief of the obstruction.
Endoscopy 04/1996; 28(3):319-22. · 5.21 Impact Factor
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ABSTRACT: Self-expanding metal stents have long been used in the management of patients with malignant esophageal and malignant biliary obstruction. The aim of the present study was to report on the palliation of malignant gastric outlet obstruction using self-expanding endoprostheses.
Between March 1993 and December 1994, 12 patients (eight women, four men, mean age 64 years) suffering from malignant gastric outlet obstruction due to recurrent gastric carcinoma (seven patients) and pancreatic head carcinoma (five patients) presented with an inability to eat and intractable vomiting. The patients were managed with peroral insertion of self-expanding metal stents.
Peroral introduction of the stent with the aid of a stabilizing overtube was successful in all patients, with the stent being supported as it was being advanced through the stenosis. Proper release of the stent into the stenotic area was achieved in all cases, relieving the intractable vomiting. The procedure was accomplished without any complications. All patients were able to eat semisolid food four days after the stent insertion. Apart from an asymptomatic partial stent occlusion in one patient, no other complications were seen during the short-term follow-up one, two, and three months after discharge.
These preliminary results suggest that self-expanding stents can effectively relieve malignant gastric outlet obstruction.
Endoscopy 03/1996; 28(2):225-8. · 5.21 Impact Factor
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ABSTRACT: N-2-cyanoacrylate (Histoacryl) and endoscopic sclerotherapy with polidocanol have both been reported to control variceal bleeding. The aim of the present study was to compare the effectiveness of the combination of Histoacryl and endoscopic sclerotherapy with polidocanol in the management of these patients regarding early rebleeding and hospital mortality rates.
One hundred twenty-six consecutive patients with variceal hemorrhage treated with injection therapy between March 1990 and July 1993 were included in this randomized prospective study. Sixty-seven patients (Group A) were treated with Histoacryl and conventional sclerotherapy with polidocanol, and 59 patients (Group B) were treated with conventional sclerotherapy with polidocanol alone. Histoacryl was injected intravariceally during the first session in the Group A patients.
A significantly lower bleeding recurrence rate was found in Group A patients who presented with active bleeding at the first treatment session (Group A: 2 of 20, Group B: 8 of 18, p < 0.05). The hospital mortality was also significantly lower in these patients (Group A: 3 of 21, Group B: 9 of 18, p < 0.05).
The combination of Histoacryl with conventional sclerotherapy with polidocanol in patients with esophageal bleeding who present with active bleeding, at the initial injection therapy, can improve the results of endoscopic management.
Endoscopy 07/1995; 27(5):355-7. · 5.21 Impact Factor
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ABSTRACT: We present here a laparoscopic transcystic papillotomy technique for the management of bile duct stones discovered either preoperatively or on intraoperative cholangiogram. Papillotomy is performed orthogradely with a hydrophilic wire-guided spincterotome inserted through the cystic duct. The correct position of the diathermic wire is verified with peroral duodenoscopy. The method has proved save and effective in our first 12 consecutive patients. Further evaluation is required to clarify its potential role in laparoscopic biliary surgery.
Endoscopy 11/1994; 26(8):697-700. · 5.21 Impact Factor
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ABSTRACT: Emergency biliary surgery for acute obstructive cholecystitis in the elderly is associated with an increased hospital mortality. We therefore attempted to drain the obstructed gallbladder via the transpapillary route in 18 patients (mean age: 67 years) who had cystic duct obstruction on ERC and who were at an increased surgical risk. A cholecystonasal catheter was successfully introduced after a small EPT in sixteen of them (89%). This resulted in effective bile drainage, obviating the need for emergency surgery in all patients. No procedure-associated morbidity or mortality was found. Following clinical remission, elective treatment consisted of ESWL/direct stone dissolution (n = 10) or elective surgery (n = 3). Three patients received no further therapy. Our results show that endoscopic gallbladder drainage may be a valuable alternative to emergency surgery in high risk patients with acute obstructive cholecystitis.
Endoscopy 09/1993; 25(6):392-5. · 5.21 Impact Factor
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ABSTRACT: Endoscopic injection of the tissue adhesive n-butyl-2-cyano-acrylate (Histoacryl) has been tried for esophageal or fundic variceal bleeding in 23 patients. Definitive hemostasis was achieved in 22 with a single injection of Histoacryl. Throughout the entire hospitalization period, which was completed with at least two weekly sessions of conventional sclerotherapy, only one recurrent bleeding was recorded. Four patients died of hepatic decompensation. It is suggested that Cyanoacrylate could overcome some of the shortcomings of conventional sclerotherapy such as early recurrent hemorrhage and bleeding from fundic varices.
Endoscopy 12/1990; 22(6):282-4. · 5.21 Impact Factor
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ABSTRACT: Endoscopic drainage was applied in 14 patients with either external or internal (bile ascites) postoperative biliary fistulas. Endoscopic sphincterotomy and/or insertion of a nasobiliary tube or an endoprosthesis was found to be a safe and effective treatment, achieving closure of fistula in all patients.
Endoscopy 10/1990; 22(5):211-3. · 5.21 Impact Factor
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ABSTRACT: This report describes the technique and results of endoscopic fistulotomy as a drainage procedure in cases of malignant obstruction of the biliary system from bulky and friable growths in the papilla of Vater. Fistulotomy, coupled with insertion of stents, was successful in seven of eight patients and was associated with relief of jaundice. It is suggested that the method be applied when conventional transpapillary insertion of stents is impossible either due to distortion of the papilla or bleeding of the growth on touch.
Surgical Endoscopy 02/1990; 4(2):88-90. · 4.01 Impact Factor
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Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 50(1):76-80. · 2.00 Impact Factor
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ABSTRACT: Background: Recent studies are testing the feasibility of an incisionless endoscopic per-oral approach to the peritoneal cavity in experimental animals. Herein we present our re-sults of peroral peritoneoscopy, liver biopsy, cholecystecto-my, fallopian tube and uterus excision, in a porcine model to determine the technical feasibility and safety of Peroral Transgastric Procedures. Methods: The procedures were performed on ten 28-50 Kgr anaesthetised pigs by using ster-ilized double channel endoscope and catheters. The gastric cavity was irrigated with antibiotic solution and access to the peritoneal cavity was gained after stomach wall incision with needle knife electrocautery. Peritoneoscopy (10 pigs), liver biopsy (1 pig), cholecystectomy (6 pigs) fallopian tube excision (one pig) and Hysterectomy (1 pig) were carried out. Four acute and six survival experiments were performed. Results: All procedures were accomplished successfully. Easily handled complications occurred in two animals. The feasibility of the peroral approach was demonstrated in all acute experiments. In the survival experiments all pigs re-covered and thrived during the following four to six weeks.Conclusion: Evidence is given that per-oral transgas-tric surgery is technically feasible and safe in a porcine model. The method has potential to become an alternative to lapar-oscopy. Further evaluation in larger series is required.
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